Anterior Cervical Discectomy and Fusion: Operative Technique and Post-Operative Complications – An Experience in a Tertiary Care Hospital

  • Muhammad Akmal
  • Omair Afzal
  • Adeeb ul Hassan Punjab Institute of Neurosciences Lahore
  • Muhammad Hassan Raza
  • Muhammad Ishfaq
  • Khalid Mahmood
Keywords: Post-operative complication of ACDF

Abstract

Background and Objective: The most common spinal procedure in our set up to address various disorders of the cervical spine like prolapsed intervertebral disc, trauma, and degenerative disc disease is an anterior cervical discectomy and fusion (ACDF). As there is no technique without complication, this procedure is also related with certain important complications. We evaluated post-operative complications of ACDF in our institution.
Material and Methods: The preoperative data of 148 patients who were operated in last 3 years for ACDF is
included in the study. Patients with previous neck surgery are excluded.
Results: The most commonly performed surgical interventions is single level ACDF (65%). Dysphagia is most
significant (16%) complication. After which neurological deterioration (9%) with equal incidence of Recurrent
Laryngeal Nerve Palsy and wound infection that is 8% each.
Conclusion: The most common post-operative complications are dysphagia and worsening of preexisting
neurology and multilevel ACDF is identified as the most common risk factor. Early recognition of complications
and management may help to reduce mortality and morbidity.

References

1. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurotic (Wien) 1989; 99:41‑50.
2. Riley LH 3rd, Vaccaro AR, Dettori JR, Hashimoto R. Postoperative dysphagia in anterior cervical spine surgery.
Spine (Phila Pa 1976) 2010;35 9 Suppl: S76‑85.
3. Hunt WE, Miller CA. Management of cervical radiculopathy. Clin Neurosurg 1986; 33:485‑502.
4. Emery SE. Cervical spondylotic myelopathy: Diagnosis and treatment. J Am Acad Orthop Surg 2001; 9:376‑88.
5. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007; 32:2310‑7.
6. Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002; 27:949‑53.
7. Li F, Gorji R, Allott G, Modes K, Lunn R, Yang ZJ. The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery: A retrospective analysis of 200 consecutive patients. J Neurosurg Anesthesiol 2012; 24:185‑90.
8. Ferrante FM, Wilson SP, Iacobo C, Orav EJ, Rocco AG, Lipson S. Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine (Phila Pa 1976) 1993; 18:730‑6.
9. Rowlingson JC, Kirschenbaum LP. Epidural analgesic techniques in the management of cervical pain. Anesth Analg 1986; 65:938‑42.
Published
2020-04-11
Section
Original Article