Complications of anterior surgery in cervical spine trauma: An overview

Kasimatis, Georgios; Panagiotopoulos, Elias; Gliatis, John; Tyllianakis, Minos; Zouboulis, P.; Lambiris, E.

doi:10.1016/j.clineuro.2008.07.009

Cited by 70 publications

(39 citation statements)

References 52 publications

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“…Chronic dysphagia is a well-known phenomenon after ACDF and plating, with a wide variability from 3% up to 21% [15,24,26,33,35]. For the early postoperative period, the rate of dysphagia in our study is similar to that in the current literature [3,18,38].…”

Section: Discussionsupporting

confidence: 89%

“…Mostly these symptoms disappear during the first 3 months after surgery [3,18], but not all patients recover completely from swallowing problems. The incidence of chronic dysphagia-related symptoms after ACDF ranges from 3% to 21% in the current literature [10,15,24,38], whereas the pathophysiologic cause still remains unclear. Additionally, the screw-plate interface might lead to postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion

Scholz

Schnake

Pingel

et al. 2011

Clinical Orthopaedics &Amp; Related Research

132

107

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion

Scholz

Schnake

Pingel

et al. 2011

Clinical Orthopaedics &Amp; Related Research

132

107

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“…Anterior cervical plates may increase interbody fusion rates [6,10,16,35] and stability [16], maintain or improve cervical sagittal alignment [18,28] and prevent interbody graft dislocation or subsidence [28], particularly in multiple-level ACDFs; however, anterior plating may also be associated with potential disadvantages and complications [17], including increased dysphagia rates [5,29,37,41], tracheoesophageal lesions [31], plate malposition and accelerated adjacent disc degeneration [31], even when low-profile plates are used. Furthermore, in patients harboring spondylotic alterations, such as anterior endplates osteophytes or extensive anterior bony ossification bridging several vertebral bodies, a careful surgical preparation of the anterior surface of the cervical spine, i.e., adequate ''flattening'' of the bony anterior cervical surface, is required to position the plate.…”

Section: Introductionmentioning

confidence: 99%

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

et al. 2013

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Purpose To analyze the prospectively collected data in a series of patients treated with single-or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinicoradiological outcome, complications and technical hints, and to review the literature on such new devices. Methods Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2-4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis. Results SF-36 and NDI showed a statistically significant improvement (p \ 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a ''focal spondylectomy'' was required. Conclusion The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

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“…2,15 The dorsal surgical approach to the cervical spine has a 4.5%-9% postoperative infection rate compared with a 0%-1% rate associated with a ventral approach. 3,7,17,21 Whereas preoperative risk factors for postoperative cervical infections (including smoking, diabetes, and intraoperative blood loss) have been investigated, few studies have assessed the quality of life (QOL) and hospital costs associated with these infections. 24,33 Quantifying cost and QOL parameters will help assess the utility of prophylactic and postoperative management strategies for postoperative wound infections.…”

mentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

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OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care system. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions. METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income. RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months postsurgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care–associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $6495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001). CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.

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Complications of anterior surgery in cervical spine trauma: An overview

Cited by 70 publications

References 52 publications

A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion

A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

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