Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

Abstract

BackgroundAfter surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders.MethodsOne hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated.ResultsPSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group.ConclusionsIncrements of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

Noninfectious prevertebral soft-tissue inflammation and hematoma eliciting swelling after anterior cervical discectomy and fusion

“…Prevertebral soft-tissue edema is reported to be associated with postoperative dysphagia that progresses after ACDF and peaks on postoperative Days 3-4. 16,18 Thereafter, it gradually improves and is normalized in 6 weeks. 14 The site most prone to swelling lies between the lower endplates of C-3 and C-4; changes at the lower level are milder than at the higher level.…”

Outcome evaluation of zero-profile implant compared with an anterior plate and cage used in anterior cervical discectomy and fusion: a two-year follow-up study

“…Plain radiographs (AP and lateral views) were performed 2 days postop and at each follow up (3 months, 12 months, and 24 months). The predominant swelling of the prevertebral soft tissue was observed at the C3 level after ACDF operation, and thus the degree of cervical prevertebral soft tissue was measured as the distance between the anterior surface of C3 vertebral body and the air shadow of the airway (22,26). In the area where the plate was fixed, the distances from the anterior margins of the plates to a shadow were measured.…”

“…A relationship between postoperative swelling of the prevertebral soft tissue and postoperative dysphagia has been reported (22,26). Increased thickness of the prevertebral soft tissue is also considered a risk factor of dysphagia.…”

Indwelling Drains Are Not Necessary for Patients Undergoing One-level Anterior Cervical Fixation Surgery

“…The PVS at the equivalent surgical intervertebral disc level was measured on the lateral view of cervical spine plain radiographs before and the day following surgery. The values obtained were corrected against the ratio 11,12 (Fig. 2).…”