Four-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Chang, Steve; Kakarla, U Kumar; Maughan, Peter H.; DeSanto, Jeff; Fox, Douglas J.; Theodore, Nicholas; Dickman, Curtis A.; Papadopoulos, Stephen M.; Sonntag, Volker K. H.

doi:10.1227/01.neu.0000367449.60796.94

Cited by 74 publications

(71 citation statements)

References 34 publications

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“…Khaki et al (48) reported 52% incidence of postoperative dysphagia in patients undergoing anterior cervical spine surgery. It has been postulated that soft tissue swelling is the most common cause of postoperative dysphagia (2,16,(68)(69)(70). However, there are studies supporting the theory that soft tissue swelling is not related to the development of postoperative dysphagia (46,48).…”

Section: Dysphagiamentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Dysphagiamentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

View full text Add to dashboard Cite

show abstract

“…Performing this technique in cases with multilevel cervical spinal canal stenosis is still debatable as regards the type of implant applied and the necessity of supplemental fixation. Studies dealing with four-level cervical discectomy and fusion are scanty and the published reports usually include a limited number of patients [1,2,5,12,13].…”

Section: Why Four-level Cervical Fusionmentioning

confidence: 99%

“…Reviewing the literature as regards multilevel anterior cervical fusion supplemented by stabilisation revealed a tendency towards the application of anterior plating rather than posterior instrumentation [1,5,7,12,13,18]. This is of course advantageous in terms of avoiding performing an additional surgery with a new posterior wound.…”

Section: Why Posterior and Not Anterior Instrumentationmentioning

confidence: 99%

“…Anterior cervical plating with tricortical iliac graft became in the later years the gold standard for cervical fusion and was applied for multilevel disease by several authors. The rate of fusion obtained was more than 90 % in most of the series [5,18]. Hwang et al studied multilevel cervical disc disease treated with titanium cage fusion with and without addition of anterior plating.…”

Section: Union and Pseudoarthrosismentioning

confidence: 99%

“…This restriction is due to the rarity of four-level cervical spine affection. Reviewing the available literature revealed scanty publications dealing with four-level cervical intersomatic fusion and the number of patients in each study is usually small [1,2,5,12,13]. A multicenter study to include a larger number of patients might be the solution to overcome this limitation.…”

Section: Limitations Of This Studymentioning

confidence: 99%

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Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation

2012

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Purpose Anterior cervical decompression and fusion is a well-established procedure for the treatment of cervical spinal canal stenosis. In this study, we evaluated the necessity of spinal instrumentation after four-level anterior cervical decompression and cage fusion. Methods From January 2006 until August 2008, 25 patients (8 females and 17 males) (mean age 63.9 ± 7.9 years) suffering from spinal stenosis C3-C7 underwent anterior decompression and interbody fusion. The patients were divided into two groups. Four-level discectomy and cage fusion was performed in all patients. In group A including nine patients, posterior instrumentation with a lateral mass screw-rod system was added, while in group B including 16 patients, additional instrumentation was not performed. The mean duration of follow-up was 48.6 months (average 25-67 months). Results Clinically, the mean value for the Neck Disability Index improved from 40 ± 23.25 at presentation to 16.31 ± 15.09 at the final follow-up. The difference between the two groups was statistically not significant. Radiologically, the criteria for solid bony fusion were achieved successfully in all patients of group A, and in 87.5 % of patients in group B. The difference between the two groups was statistically not significant. The fused segment was then evaluated in the sagittal radiographs as regards the height and the lordosis angle. The loss in the height as well as the loss in the lordosis angle was more when posterior instrumentation was not added. However, the difference between the two groups was not statistically significant. Conclusion Stand-alone intersomatic cage fusion is an acceptable line of treatment for four-level cervical disc disease, both clinically and radiologically. Although the addition of posterior instrumentation yields better radiological results, the difference does not reach the statistical significance level.

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Surgical Technique of Anterior Cervical Discectomy and Fusion (ACDF)

Rao

Michael

Timothy

2011

Practical Procedures in Elective Orthopedic Surgery

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Four-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Abstract: In carefully selected patients, 4-level anterior cervical discectomy and fusion with plating can be associated with high rates of fusion. The technique is safe and effective for managing multilevel cervical spondylotic myelopathy and may obviate the need for circumferential procedures.

Cited by 74 publications

References 34 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation

Surgical Technique of Anterior Cervical Discectomy and Fusion (ACDF)

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