Perioperative Complications of Combined Anterior and Posterior Cervical Decompression and Fusion Crossing the Cervico-Thoracic Junction

Hart, Robert A.; Tatsumi, Robert L.; Hiratzka, Jayme; Yoo, Jung U.

doi:10.1097/brs.0b013e318190affe

Cited by 40 publications

(44 citation statements)

References 21 publications

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“…Anterior surgical strategies are increasingly recognized as advantageous for multilevel cervical decompression of the anteriorly compromised spinal cord, providing the ability for anterior release, durable reconstruction of physiologic alignment and instrumented fusion through a less traumatic approach compared to the posterior neck dissection [3,6,20,37,38,40,[45][46][47]55]. With anterior procedures, decompression of the neurologic structures can be accomplished by means of segmental discectomy or partial corpectomy.…”

Section: Introductionmentioning

confidence: 99%

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

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Clinical studies reported frequent failure with anterior instrumented multilevel cervical corpectomies. Hence, posterior augmentation was recommended but necessitates a second approach. Thus, an author group evaluated the feasibility, pull-out characteristics, and accuracy of anterior transpedicular screw (ATPS) fixation. Although first success with clinical application of ATPS has already been reported, no data exist on biomechanical characteristics of an ATPS-plate system enabling transpedicular end-level fixation in advanced instabilities. Therefore, we evaluated biomechanical qualities of an ATPS prototype C4-C7 for reduction of range of motion (ROM) and primary stability in a non-destructive setup among five constructs: anterior plate, posterior all-lateral mass screw construct, posterior construct with lateral mass screws C5 ? C6 and end-level fixation using pedicle screws unilaterally or bilaterally, and a 360°construct. 12 human spines C3-T1 were divided into two groups. Four constructs were tested in group 1 and three in group 2; the ATPS prototypes were tested in both groups. Specimens were subjected to flexibility test in a spine motion tester at intact state and after 2-level corpectomy C5-C6 with subsequent reconstruction using a distractable cage and one of the osteosynthesis mentioned above. ROM in flexionextension, axial rotation, and lateral bending was reported as normalized values. All instrumentations but the anterior plate showed significant reduction of ROM for all directions compared to the intact state. The 360°construct outperformed all others in terms of reducing ROM. While there were no significant differences between the 360°a nd posterior constructs in flexion-extension and lateral bending, the 360°constructs were significantly more stable in axial rotation. Concerning primary stability of ATPS prototypes, there were no significant differences compared to posterior-only constructs in flexion-extension and axial rotation. The 360°construct showed significant differences to the ATPS prototypes in flexionextension, while no significant differences existed in axial rotation. But in lateral bending, the ATPS prototype and the anterior plate performed significantly worse than the posterior constructs. ATPS was shown to confer increased primary stability compared to the anterior plate in flexion-extension and axial rotation with the latter yielding significance. We showed that primary stability after 2-level corpectomy reconstruction using ATPS prototypes compared favorably to posterior systems and superior to anterior plates. From the biomechanical point, the 360°i nstrumentation was shown the most efficient for reconstruction of 2-level corpectomies. Further studies will elucidate whether fatigue testing will enhance the benefit of transpedicular anchorage with posterior constructs and ATPS.

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Section: Introductionmentioning

confidence: 99%

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

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“…In studies investigating combined anterior-posterior cervical procedures, Hart el al. 8 and Aryan et al 1 reported dysphagia rates of 46% and 19%, respectively. Although all cases of dysphagia with follow-up data in our study resolved subjectively by 12 months, there is morbidity associated with such complications; 61.5% and 38.5% of the cases required NG and PEG tube placement, respectively.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia following combined anterior-posterior cervical spine surgeries

Chen

Saulle

et al. 2013

SPI

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C ompliCations related to cervical spine surgery are well documented in the literature, including dysphagia, dysphonia, wound infection, neurological deficit, delayed C-5 palsy, adjacent-level disease, instrumentation failure, and pseudarthrosis. 4,7 Among these, dysphagia has been a consistently recognized early complication following anterior cervical spine surgery, and its reported incidence is highly variable, ranging from 1% to as high as 79%. 2,3,5,6,10,14,22,24,28,33 This variation is in part attributed to how dysphagia is defined by investigators and the threshold of severity at which it is considered to be a complication. Fortunately, most studies show dysphagia to be typically a transient phenomenon following anterior cervical surgery. 2,22,31 The pathophysiology of dysphagia following cervical spine surgery remains poorly understood. Several factors have been suggested to be related to the development of postsurgical dysphagia, including patient age, female sex, obesity, length of surgery, specific spinal level(s) of surgery, multilevel surgery, use of instrumen- Object. This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries.Methods. The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and/or fiberoptic endoscopic evaluation of swallowing/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed.Results. In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2-7 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput-C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No ...

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“…This approach may be properly extended to expose T3-T4 in accordance with the need of the condition of patients, and it partially splits the sternum and does not enter the thoracic cavity so that respiratory or circulatory systems are less disturbed and fewer postoperative complications appear. For the anterior operation, selecting a left approach or right approach has no significant difference for the surgeon to operate; however, because during the operation the distal vertebral body is usually unclearly exposed and needed long traction, postoperative recurrent laryngeal nerve injury easily appears and the literature reports that the incidence is as high as 46 % [21]. At the fourth thoracic vertebra level, the left recurrent laryngeal nerve travels into the tracheoesophageal groove from the upper thoracic outlet and during the traction process it is not easily damaged, therefore, the use of the left approach is more reasonable than the right one.…”

Section: Discussionmentioning

confidence: 97%

One-stage combined anterior-posterior approach treatment of multiple cervicothoracic spinal tuberculosis with kyphosis

Zhang

Yin

et al. 2015

International Orthopaedics (SICOT)

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Perioperative Complications of Combined Anterior and Posterior Cervical Decompression and Fusion Crossing the Cervico-Thoracic Junction

Cited by 40 publications

References 21 publications

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

Dysphagia following combined anterior-posterior cervical spine surgeries

One-stage combined anterior-posterior approach treatment of multiple cervicothoracic spinal tuberculosis with kyphosis

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