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

Yagi, Kenji; Nakagawa, Hiroshi; Okazaki, Toshiyuki; Irie, Shinsuke; Inagaki, Toru; Saito, Osamu; Saijo, Nagahiro; Saito, Koji

doi:10.3171/2016.9.spine16520

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…Fourth, the patients in Group I had type II incision that might cause more significantly elevated postoperative WBC count and severer inflammatory reactions than in Groups II and III. A previous study showed that the patients who developed PVST swelling-related complications had more elevated WBC and C-reactive proteins than those who did not have complications (36), supporting the present study. It was once reported that if a patient had three or more vertebral segments exposed, C2, C3, and C4 segments involved, blood loss of over 300 ml, operation duration exceeding 5 h, or preoperative spinal dysfunction, he/she might be more likely to have postoperative PVST swelling and respiratory tract-related complications (6).…”

Section: Discussionsupporting

confidence: 90%

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Dai¹,

Liu²,

Chen³

et al. 2022

Acta Orthop Belg

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Atlantoaxial segments have not been discussed in existing studies on prevertebral soft tissue (PVST) swelling after cervical operations. This study aimed to investigate the characteristics of PVST swelling after anterior cervical internal fixation at different segments. This retrospective study included patients who underwent transoral atlantoaxial reduction plate (TARP) internal fixation (Group I, n=73), C3/C4 anterior decompression and vertebral fixation (Group II, n=77), or C5/C6 anterior decompression and vertebral fixation (Group III, n=75) at our Hospital. The PVST thickness at C2, C3, and C4 segments was measured before and 3 days after the operation. Time of extubation, number of patients with postoperative re-intubation and dysphagia were collected. Results show that all patients had significant postoperative PVST thickening (all P<0.01). PVST thickening at C2, C3, and C4 was significantly greater in Group I than in Groups II and III (all P<0.01). PVST thickening at C2, C3, and C4 in Group I was 1.87 (14.12mm/7.54mm), 1.82 (12.90mm/7.07mm) and 1.71 (12.09mm/7.07mm) times of that in Group II, respectively. PVST thickening at C2, C3, and C4 in Group I was 2.66 (14.12mm/5.31mm), 1.50 (12.90mm/8.62mm) and 1.32 (12.09mm/9.18mm) times of that in Group III, respectively. The patients in Group I had significantly later postoperative extubation (Both P<0.01) than the patients in Groups II and III. None of the patients had postoperative re-intubation or dysphagia. We conclude that PVST swelling was greater in patients who underwent TARP internal fixation than in patients who underwent anterior C3/C4 or C5/C6 internal fixation. Hence, after TARP internal fixation, patients should be given proper respiratory tract management and monitoring.

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Section: Discussionsupporting

confidence: 90%

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Dai¹,

Liu²,

Chen³

et al. 2022

Acta Orthop Belg

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“…Noninfectious prevertebral soft-tissue inflammation is one of the reasons for PSTS after ACDF, and some studies suggested that local soft-tissue swelling is one of the most common reasons for dysphagia after ACDF 7,35 . According to the results, studies that hold a positive attitude found that LSA effectively alleviated PSTS within 2 weeks postoperatively 18,22,26 .…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion

Wang

Shi

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: A systematic review and meta-analysis. Objective: To evaluate the safety and efficacy of local steroid application (LSA) on dysphagia after anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Dysphagia is one of the most common adverse events in the early postoperative period of ACDF. LSA is reported as an effective method to reduce the swelling of soft tissues, thereby decreasing the incidence of dysphagia. However, the safety and efficacy of LSA on dysphagia after ACDF need to be systematically reviewed and analyzed. Methods: A comprehensive literature search was carried out in the database PubMed, Web of Science, EMBASE, Clinical key, Cochrane library, and Wiley Online Library to screen papers that report LSA in ACDF surgery. The Cochrane Collaboration tool and a methodological index for nonrandomized studies were used for the assessment of study quality. Data were analyzed with the Review Manager 5.3 software. Results: A total of 10 studies were included. The results revealed no significant differences between the steroid group and the control group in ACDF regarding postoperative drainage, estimated blood loss, and neck disability index score (P > 0.05). LSA significantly alleviates visual analog scale score for neck pain (or odynophagia) (P < 0.05), reduces the length of hospital stay (weighted mean difference, −1.00 (−1.05 to −0.95); P < 0.001), and mitigates dysphagia rate and prevertebral soft-tissue swelling in the early postoperative period (P < 0.05). There seemed to be no significant increase in the complication rate and steroid-related adverse events in the steroid group compared with the control group (P < 0.05). Conclusions: LSA shows advantages in reducing the length of hospital stay, decreasing dysphagia rate, and mitigating prevertebral soft-tissue swelling in the early postoperative period of ACDF. Further large-scale studies are urgently required for the development of a standard protocol for LSA and further analysis of potential delay complications.

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“…Yagi et al found that prevertebral soft tissue edema was related to severe dysphagia and odynophagia after anterior cervical discectomy and fusion. [19] Studies showed that prevertebral soft tissue edema was associated with postoperative dysphagia that peaked at 3 to 4 days after anterior cervical spinal surgery, prevertebral soft tissue edema was considered as tissue damage. [20,21] Other studies suggested the intermittent release of retractors to minimize the injury of compression-associated tissue ischemia.…”

Section: Discussionmentioning

confidence: 99%

The role of esophageal area for dysphagia after anterior cervical corpectomy fusion: Change trends and risk factors

Sang

Chen

2023

Medicine

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The objective of this study is to assess the change trends of perioperative esophageal area for anterior cervical corpectomy fusion (ACCF) and to analyze the risk factors of the area for postoperative dysphagia. We retrospectively analyzed 309 patients who underwent ACCF due to degenerative cervical diseases between November 2015 and September 2019 at our hospital. Patients were divided into 2 groups named the dysphagia group and the normal swallowing function group, according to the swallowing function after ACCF. The esophageal area was measured at T1 level using computed tomography axial plane images before and after surgery (1 week, 1 month, 8 months, and 12 months), in order to assess the change trends of esophageal area perioperatively and analyze risk factors of the area for dysphagia after ACCF. The area was highest at 1 week after surgery and would be decreased over time in both groups, which was recovered to the preoperative levels in 12 months after surgery. The incidence of dysphagia after ACCF was 41.1%. In the dysphagia group, 127 patients (mean age 59.299 years) had dysphagia after ACCF. In the normal-swallowing function group, 182 patients (mean age 59.8352 years) had normal swallowing function after ACCF. The preoperative esophageal area was larger in the dysphagia group than in the normal-swallowing function group. Preoperative esophageal area was correlated with postoperative dysphagia (odds ratio: 1.3457, 95% confidence interval: 1.106-1.637). When the esophageal area at preoperation was above 3.388 cm 2 , the risk of postoperative dysphagia was higher. The esophageal area was the biggest at 1 week postoperatively, significantly decreased over time and would be recovered to the normal size at 12 months after surgery. Preoperative esophageal area should be considered when evaluating the risk factor for dysphagia after ACCF.

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

Cited by 11 publications

References 17 publications

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion

The role of esophageal area for dysphagia after anterior cervical corpectomy fusion: Change trends and risk factors

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