Anterior cervical spine surgery-associated complications in a retrospective case-control study

Abstract

Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

Keywords: Anterior cervical spine surgery; complications; outcome.

Figure 1

Patient flow chart of the current study. One hundred and fourteen patients underwent anterior cervical spine surgery in our institution over a 6-year period (January 2009 to December 2014). Complications presented in 14 patients, which formed our “Cases” group. The remaining 100 patients were used as the “Control” group. In 10 cases complications developed in the perioperative period, while the remaining 4 cases presented with 5 delayed complications. One patient developed implant failure that caused a trachea-esophageal fistula (*).

Figure 2

Boxplot of the age distribution among cases and controls. There was no statistical difference in the age distribution between the two groups, as tested by the Welch two sample t-test.

Figure 3

Bar-plot of the complications according to the gender. The absolute number of complications was not statistically different between the two genders, as tested by the Chi-square test.

Figure 4

Bar-plot of the complications according to the crude diagnosis (traumatic vs. degenerative disorders). The absolute number of complications did not vary according to the patient’s crude diagnosis, as tested by the Chi-square test.

Figure 5

Bar-plot of the complications according to the primary presenting symptoms. The absolute number of complications did not differ according to the presenting symptom, as tested by the Chi-square test.

Figure 6

Bar-plot of the complications according to the surgical procedure. The absolute number of complications did not differ according to the surgical procedure, as tested by the Chi-square test. ACCF, anterior cervical corpectomy and fusion; ACDF, anterior cervical discectomy and fusion; ACDF-P, anterior cervical discectomy and fusion with plating.

Figure 7

Odds ratio plot of risk factors for the development of complications after anterior cervical spine surgery. Males and patients older than 50 years of age have an increased tendency to develop complications. On the contrary, patients with traumatic disorders and more than two-level surgery showed decreased tendency to develop complications. However, none of these tendencies reached a statistically significant level according to the logistic regression.

Figure 8

Receiver operating characteristic (ROC) curve of the logistic regression. The area under the curve indicates that the predictive value of the logistic model using the gender, age, diagnosis, type of surgical procedure, and length of fusion is low.