Current Concepts of Anterior Cervical Discectomy and Fusion: A Review of Literature

Song, Kyung-Jin; Choi, Byeong-Yeol

doi:10.4184/asj.2014.8.4.531

Cited by 74 publications

(55 citation statements)

References 71 publications

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“…10,21 However, both physicians and hospital systems have expressed concern about the impact of obesity on the outcomes and costs of spinal procedures. Previous studies have demonstrated that obesity is associated with longer operative times and increased blood loss during spinal surgery.…”

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confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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“…Cage with bone grafts is good to sustain axial loading and the locking plates in addition to preventing rotation provides good load sharing device. 9 In our series, out of 3 cases with burst fractures neurological deficit was improved to normal only in one case.…”

Section: Discussionmentioning

confidence: 88%

Lower cervical trauma an orthopaedician domain

Charan

2017

Int J Res Orthop

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Background: Lower cervical spinal injuries are potentially devastating injuries of the axial skeleton. Many effective procedures are available for degenerative cervical spinal injuries that are unresponsive to conservative management. Our present aimed to observe the outcome for the treatment of different types of spinal injuries based onASIA impairment scale (modified Frankels scoring system) by using different treatment concepts.Methods: This study was conducted at Indira Gandhi institute of medical sciences and Nalanda medical college during the period 2012 – 2015. 14 patients with lower cervical spine injury attended to emergency department were included in the study. All the 14 cases were operated by different surgical procedures based on type of injury. The outcome was measured by using ASIA impairment scale (modified Frankels scoring system).Results: Out of 14 cases, 3 were burst fractures, 4 were unilateral facet dislocations, 5 were bilateral facet dislocations and 2 with distractive extension injury. Cases with burst fractures operated with corpectomy with cage and plate, for unilateral and bilateral dislocations open reduction and Bohlmantriple-wiring and posterior fusion was done and for distraction injury, open reduction and anterior plating was done. Improvement in Frankel scoring system was good in about 3 cases with unilateral dislocations. Overall, neurological recovery was observed in 35% cases. Recovery was much better in Quadriparesis patients. None of the patients had iatrogenic paresis. Conclusions: Satisfactory results and outcome was observed in unilateral facet dislocations after treatment by open reduction and Bohlman triple-wiring and posterior fusion. The outcome in bilateral facet dislocations was poor as they are easily reduced with closed traction methods.

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“…This procedure generally provides good clinical results and high patient satisfaction scores [1]. Postoperative dysphagia is a common consequence of an anterior exposure following ACDF, and can occur in up to 71% of patients in the early postoperative period [2].…”

Section: Introductionmentioning

confidence: 99%

Does cervical disc arthroplasty have lower incidence of dysphagia than anterior cervical discectomy and fusion? A meta-analysis

Zhong

Zhen

et al. 2016

Clinical Neurology and Neurosurgery

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Current Concepts of Anterior Cervical Discectomy and Fusion: A Review of Literature

Cited by 74 publications

References 71 publications

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Lower cervical trauma an orthopaedician domain

Does cervical disc arthroplasty have lower incidence of dysphagia than anterior cervical discectomy and fusion? A meta-analysis

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