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Awareness of Potential Complications with Anterior Cervical Discectomy Allows for Successful Management

Posted on: 11/30/1999
Among the many people in the United States who have spinal surgeries, the most common procedure is called the anterior cervical discectomy and fusion (ACDF). This surgery involves removing a disc and fusing together vertebrae. According to the authors of this study, over 50,000 ACDFs have been done in the US between 1990 and 1999.

Generally, most patients experience good results from the surgery, however, some do experience complications that can be life-threatening. The study's authors reviewed the files of 549 men and 466 women, all between the ages of 28 and 75 years, who underwent ACDF due to degenerative disc disease, provided they had not undergone previous neck surgery. The goal of the study was to document the potential complications and management issues.

The patients' files included results of pre-surgical cervical (neck) magnetic resonance imaging (MRI) for all patients and computed tomography scan (CT scan) for 445 patients, x-rays for 670 patients, cervical myelogram (x-ray with dye) followed by CT scan for 224 patients, and tests to check nerve conduction in the arms (called electromyography) in 119 patients.

Grafts used were either autologous (from the patient's own bone tissue) or allografts, from others, if the surgeons determined that autografts were not an option due to disorders, such as hyperparathyroidism, Paget's disease, osteoporosis, and others. A history of heavy smoking was also a deciding factor in using allografts over autologous grafts.

The researchers then reviewed the follow-up findings for each patient, searching for any complications noted during the surgery, at 2 and 4 weeks after, and then again at 3, 6 and 12 months after. They found, through x-rays, that at 12 months, fusion was successful in 94.5 percent of the patients. In terms of complications, 9.5 percent of the patients complained of difficulty swallowing, coughing, choking, new-onset of heartburn, or feeling as if their neck was blocked, after the surgery. Of the 97 patients with these complaints, only 5 did not resolve spontaneously within 7 days. They did, however, resolve within the following 4 weeks.

A hematoma (a collection of clotted blood) that caused severe dysphagia, difficulty breathing, or painful swelling in the neck occurred in 5.6 percent of patients. Surgery was needed to remove the hematoma in 2.4 percent of the affected patients. recurrent laryngeal nerve palsy (RLN palsy), which caused hoarseness of the voice, occurred in 3.1 percent of patients.

In 5 patients (0.5 percent), there was leakage of cerebral spinal fluid; in 4 cases, this happened accidentally, in the last case, a surgical procedure opened the area. Three patients (0.3 percent) experienced an accidental opening of the esophagus during surgery, but this was repaired immediately in 2 patients. The third patient's tear was not noticed during surgery and it was discovered on the second day after surgery when he developed a fever. Despite aggressive treatment, including surgical repair and antibiotics, the patient died after 10 days.

Two patients experienced worsening symptoms of myelopathy, or disease effects to the spinal cord, that appeared to improve after 12 weeks of therapy. One patient developed temporary Horner's syndrome on one side of the face. The symptoms of Horner's syndrome include flushing skin but no sweat, a small (constricted) pupil, and drooping eyelid. Finally, one patient presented 16 months following the surgery with movement of the screws from the fusion area. The researchers determined that the screws had not been placed properly during surgery.

The authors concluded that the most common complication is that of dysphagia and hematomas, followed by nerve palsy. Although not common, perforation of the esophagus is life threatening.

Kostas N. Fountas, MD, PhD, et al. Anterior Cervical Discectomy and Fusion Associated Complications. In SPINE. October 2007. Vol. 32. No. 21. Pp. 2310-2317.

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