Perioperative complications with multilevel anterior and posterior cervical decompression and fusion

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Cervical spondylotic myelopathy (CSM) is a progressive degenerative pathology that frequently affects older individuals and causes spinal cord compression with symptoms of neck pain, radiculopathy, and weakness. Anterior decompression and fusion is the primary intervention to prevent neurological deterioration; however, in severe cases, circumferential decompression and fusion is necessary. Published data regarding perioperative morbidity associated with these complex operations are scarce. In this study, the authors sought to add to this important body of literature by documenting a large single-surgeon experience of single-session circumferential cervical decompression and fusion.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective analysis was performed to identify intended single-stage anterior-posterior or posterior-anterior-posterior cervical spine decompression and fusion surgeries performed by the primary surgeon (V.C.T.) at Rush University Medical Center between 2009 and 2016. Cases in which true anterior-posterior cervical decompression and fusion was not performed (i.e., those involving anterior-only, posterior-only, or delayed circumferential fusion) were excluded from analysis. Data including standard patient demographic information, comorbidities, previous surgeries, and intraoperative course, along with postoperative outcomes and complications, were collected and analyzed. Perioperative morbidity was recorded during the 90 days following surgery.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Seventy-two patients (29 male and 43 female, mean age 57.6 years) were included in the study. Fourteen patients (19.4%) were active smokers, and 56.9% had hypertension, the most common comorbidity. The most common clinical presentation was neck pain in 57 patients (79.2%). Twenty-three patients (31.9%) had myelopathy, and 32 patients (44.4%) had undergone prior cervical spine surgery. Average blood loss was 613 ml. Injury to the vertebral artery was encountered in 1 patient (1.4%). Recurrent laryngeal nerve palsy was observed in 2 patients (2.8%). Two patients (2.8%) had transient unilateral hand grip weakness. There were no permanent neurological deficits. Dysphagia was encountered in 45 patients (62.5%) postoperatively, with 23 (32%) requiring nasogastric parenteral nutrition and 9 (12.5%) patients ultimately undergoing percutaneous endoscopic gastrostomy (PEG) placement. Nine of the 72 patients required a tracheostomy. The incidence of pneumonia was 6.9% (5 patients) overall, and 2 of these patients were in the tracheostomy group. Superficial wound infections occurred in 4 patients (5.6%). Perioperative death occurred in 1 patient. Reoperation was necessary in 10 patients (13.9%). Major perioperative complications (permanent neurological deficit, vascular injury, tracheostomy, PEG tube, stroke, or death) occurred in 30.6% of patients. The risk of minor perioperative complications (temporary deficit, dysphagia, deep vein thrombosis, pulmonary embolism, urinary tract infection, pneumonia, or wound infection) was 80.6%.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Single-session anterior-posterior cervical decompression and fusion is an inherently morbid operation required in select patients with cervical spondylotic myelopathy. In this large single-surgeon series, there was a major perioperative complication risk of 30.6% and minor perioperative complication risk of 80.6%. This overall elevated risk for postoperative complications must be carefully considered and discussed with the patient preoperatively. In some situations, shared decision making may lead to the conclusion that a procedure of lesser magnitude may be more appropriate.</jats:p></jats:sec>

Variation in Prevertebral Soft Tissue Swelling after Staged Combined Multilevel Anterior–Posterior Complex Cervical Spine Surgery: Anterior Then Posterior (AP) versus Posterior Then Anterior–Posterior (PAP) Surgery

“…They concluded that the incidence of emergency airway management was greater in combined anterior–posterior cervical spine surgery [ 27 ]. Wewel et al reported that, out of seventy-two patients who underwent PAP and AP surgeries, six had delayed extubation, and three had reintubation [ 32 ]. The reintubation of 9 patients out of 880 that underwent elective cervical surgery, 3 of whom underwent combined anterior–posterior surgery, was also reported by Schroeder et al [ 33 ].…”

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

“…In previous studies, complication rates in NCP patients who underwent cervical surgery due to CSM were 9–30% [ 17 , 23 , 26 , 31 ]. Yaszay et al [ 33 ] reported a rate of 36% for postoperative major complications (e.g., wound infections, pulmonary issues, instrument-related complications) in patients with CP with >2 years of follow-up after spinal surgery, with a spine-related reoperation rate of 14.0%.…”

Cervical Spondylotic Myelopathy: An Updated Review

“…In addition, the study included osteotomies in the surgical procedures. Wewel, et al [53] reported a major complication rate of 30.6% for a single-stage anterior-posterior or posterior-anterior-posterior decompression and fusion (Table 2). In addition, the highest minor complication was identified as dysphagia (62.5%).…”