High anterior cervical approach to the upper cervical spine

Park, Seong‐Hyun; Sung, Joo-Kyung; Lee, Sun-Ho; Park, Jaechan; Hwang, Jeong-In; Hwang, Sung-Kyoo

doi:10.1016/j.surneu.2006.11.070

Cited by 67 publications

(61 citation statements)

References 16 publications

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“…VCP may be due to sectioning or retraction injury of the RLN, retraction of the esophagus with reduced perfusion, 21 direct pharyngeal or esophageal pressure, 22 hypoglossal nerve injury, 35 or alteration in C2-7 angle. 36,47 Injury to the superior laryngeal nerve (particularly in high approaches) is also a cited cause, and although not well documented in the ACDF literature, is a well-known cause of dysphagia following oncological surgery of the neck.…”

Section: Discussionmentioning

confidence: 99%

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEDysphagia and vocal cord palsy (VCP) are common complications after anterior cervical discectomy and fusion (ACDF). The reported incidence rates for dysphagia and VCP are variable. When videolaryngostroboscopy (VLS) is performed to assess vocal cord function after ACDF procedures, the incidence of VCP is reported to be as high as 22%. The incidence of dysphagia ranges widely, with estimates up to 71%. However, to the authors’ knowledge, there are no prospective studies that demonstrate the rates of VCP and dysphagia for reoperative ACDF. This study aimed to investigate the incidence of voice and swallowing disturbances before and after reoperative ACDF using a 2-team operative approach with comprehensive pre- and postoperative assessment of swallowing, direct vocal cord visualization, and clinical neurosurgical outcomes.METHODSA convenience sample of sequential patients who were identified as requiring reoperative ACDF by the senior spinal neurosurgeon at the University of Alabama at Birmingham were enrolled in a prospective, nonrandomized study during the period from May 2010 until July 2014. Sixty-seven patients undergoing revision ACDF were enrolled using a 2-team approach with neurosurgery and otolaryngology. Dysphagia was assessed both preoperatively and postoperatively using the MD Anderson Dysphagia Inventory (MDADI) and fiberoptic endoscopic evaluation of swallowing (FEES), whereas VCP was assessed using direct visualization with VLS.RESULTSFive patients (7.5%) developed a new postoperative temporary VCP after reoperative ACDF. All of these cases resolved by 2 months postoperatively. There were no new instances of permanent VCP. Twenty-five patients had a new swallowing disturbance detected on FEES compared with their baseline assessment, with most being mild and requiring no intervention. Nearly 60% of patients showed a decrease in their postoperative MDADI scores, particularly within the physical subset.CONCLUSIONSA 2-team approach to reoperative ACDF was safe and effective, with no new cases of VCP on postoperative VLS. Dysphagia rates as assessed through the MDADI scale and FEES were consistent with other published reports.

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Section: Discussionmentioning

confidence: 99%

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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“…Park et al 106 described a prevascular extraoral retropharyngeal approach to the upper cervical spine, including a case of C2-4 OPLL. They reported that this approach is relatively safe.…”

mentioning

confidence: 99%

Ossification of the posterior longitudinal ligament: a review

Saetia

Cho

Lee

et al. 2011

FOC

116

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Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.

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“…Dysphagia and Dysphonia are known complications after anterior cervical spine procedures Dysphagia could be secondary to the injury of superior 25 , recurrent laryngeal nerve 26 , hypoglossal 27 and glossopharyngeal nerve 25 . The incidence of this complication varies from 2 to 50 % depending on the type of study and evaluation methodology 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

Muralidharan

Loke

Habeych

et al. 2016

Journal of Clinical Neuroscience

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Abstract:Objective: The primary aim of this study is to conduct a systematic review of reports concerning patients with cervical spondylotic myelopathy to assess the value of intraoperative monitoring (IOM), such as SSEPs, TcMEPs, and EMG, in anterior cervical procedures. Methods: A search strategy was first conducted in order to collect a small database of relevant papers using key words describing both disorders and procedures of interest. The database was then shortlisted using selection criteria and data from these finalized reports was extracted to identify complications as a result of anterior cervical procedures treating cervical spondylotic myelopathy for outcome analysis on a continuous scale. Results: In the 22 studies that matched the screening criteria, only two involved the use of IOM. The 22 studies had an average of 173 patients. In studies with procedures done without IOM a mean change in JOA score of 3.94 points and a mean change in Nurick score by 1.20 points (both less severe post-op) were observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia had a mean outcome of 2.71% of cases for studies without IOM and a mean outcome of 0.91% of cases for studies with IOM. Conclusions: Based on the review of published studies sufficient evidence does not exist to negate or reinforce the use of IOM in hopes of reducing neurological complications during anterior cervical procedures. There is no standardized evaluation method to measure these complications. In addition, the modalities used for IOM have not been overwhelmingly confirmed.

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High anterior cervical approach to the upper cervical spine

Cited by 67 publications

References 16 publications

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Ossification of the posterior longitudinal ligament: a review

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

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