Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon's experience of 1,576 patients

Abstract

Background: Although anterior cervical diskectomy and fusion (ACDF) is a safe and effective procedure, the complications associated with it cannot be underestimated. The aim of this study was to highlight the potential complications associated with ACDF and the strategies to avoid them.

Methods: A total of 1576 patients was included in this retrospective study from 1995 to 2012. All patients were operated by a single surgeon, who used the standard technique. Data pertaining to the postoperative complications and mortality were collected from the database.

Results: The overall ACDF-related complication rate in our series was 8.4% (n = 133). Dysphagia was the most common complication encountered in 3.3 % (n = 52) of our patients. The inadvertent dural tear was encountered in 1.3% (n = 20) of our patients. Hoarseness was seen in 1.2% (n = 19) of our patients. A total of 0.88% (n = 14) of the patients had worsening of myelopathy/radiculopathy in the immediate postoperative period. Superficial wound infection occurred in 0.2% (n = 3) of our patients. Postoperative neck hematoma was seen in 0.1% (n = 2), recurrent laryngeal nerve palsy in 0.1% (n = 2), esophageal tear in 0.1% (n = 1), and graft extrusion in 0.88% (n = 14) of our cases. There was 0.1% (n = 1) mortality in our series. Of all these complications, only dysphagia was significantly correlated with 3-level ACDF as compared to 1- or 2-level ACDF (H = 12.89, df= 3, P = 0.05).

Conclusion: ACDF is a relatively safe procedure with very low morbidity and almost no mortality. In this study, the common complications encountered were postoperative dysphagia, dural injury, and hoarseness.

Keywords: Anterior; Cervical; Complications; Diskectomy; Fusion.