Nerve Transfers After Cervical Spine Surgery: Multi-Institutional Case Series and Review of the Literature

Study Design: Case series and systematic review of the Literature. Objectives: Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. Methods: Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. Results: Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. Conclusions: PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients

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Esophageal Perforation Associated with Cervical Spine Surgery: Report of Two Cases and Review of the Literature

Digestive Surgery ◽

10.1159/000079495 ◽

2004 ◽

Vol 21 (3) ◽

pp. 246-249 ◽

Cited By ~ 39

Author(s):

B.C. Vrouenraets ◽

H.D. Been ◽

R. Brouwer-Mladin ◽

M. Bruno ◽

J.J.B. van Lanschot

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Esophageal Perforation ◽

Review Of The Literature ◽

Cervical Spine Surgery

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Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

Global Spine Journal ◽

10.1177/2192568216687535 ◽

2017 ◽

Vol 7 (1_suppl) ◽

pp. 28S-36S ◽

Cited By ~ 13

Author(s):

Stuart H. Hershman ◽

William A. Kunkle ◽

Michael P. Kelly ◽

Jacob M. Buchowski ◽

Wilson Z. Ray ◽

...

Keyword(s):

Case Report ◽

Cervical Spine ◽

Spine Surgery ◽

Esophageal Perforation ◽

Review Of The Literature ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery

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Frequency, recognition, and management of postoperative hematomas following anterior cervical spine surgery: A review

Surgical Neurology International ◽

10.25259/sni_669_2020 ◽

2020 ◽

Vol 11 ◽

pp. 356

Author(s):

Nancy Epstein

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Early Recognition ◽

Case Reports ◽

Case Series ◽

Improvement Program ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Cervical Surgery ◽

Anterior Corpectomy

Background: We reviewed the frequency, recognition, and management of postoperative hematomas (HT) (i.e. retropharyngeal [RFH], wound [WH], and/or spinal epidural hematomas [SEH]) following anterior cervical discectomy/fusion (ACDF), anterior corpectomy fusion (ACF), and/or anterior cervical spine surgery (ACSS). Methods: Postoperative cervical hematomas following ACDF, ACF, and ACSS ranged from 0.4% to 1.2% in a series of 11 studies involving a total of 44, 030 patients. These included; 4 single case reports, 2 small case series (6 and 30 cases), 4 larger series (758–2375 for a total of 6729 patients), an a large NSQUIP (National Surgical Quality Improvement Program ) Database involving 37,261 ACDF patients. Results: Risk factors contributing to postoperative cervical hematomas included; DISH (diffuse idiopathic skeletal hyperostosis), ossification of the posterior longitudinal ligament (OPLL), therpeutic heparin levels, longer operative times, multilevel surgery, ASA Scores of +/= 3, (American Society of Anesthesiologists), prone surgery, operative times > 4 hours, smoking, higher/lower body mass index (BMI), anemia, age >65, > medical comorbidities, and male gender. Notably, the use of drains did not prevent HT, and did not increase the infection, or reoperation rates. Conclusion: In our review of 11 studies focused on anterior cervical surgery, the incidence of postoperative hematomas ranged from 0.4 to 1.2%. Early recognition of these postoperative hemorrhages, and appropriate management (surgical/non-surgical) are critical to optimize recovery, and limit morbidity, and mortality.

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Emerging cervical spine surgery in Chitwan Medical College: A case series

Journal of Chitwan Medical College ◽

10.3126/jcmc.v7i1.17370 ◽

2017 ◽

Vol 7 (1) ◽

pp. 47-49

Author(s):

Akesh Prajapati ◽

Jyoti Sitaula ◽

Bishnu Dev Sharma ◽

Sujit Shrestha ◽

Pujan Pant

Keyword(s):

Cervical Spine ◽

Respiratory Distress ◽

Spine Surgery ◽

Scoring System ◽

Case Series ◽

Tuberculous Spondylitis ◽

Cervical Corpectomy ◽

Cervical Spine Surgery ◽

Medical College ◽

Anterior Cervical Corpectomy

We report 10 consecutive patients who underwent anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) from Nov 2015. Nine of these patients sustained fracture or dislocation of cervical spine and one patient had tuberculous spondylitis. Eight patients improved by at least one grade (Frankel spinal scoring system) post operatively while 2 patients who had respiratory distress pre-operatively expired on 3rd and 21st post operative day.

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Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Spinal Cord ◽

10.1038/sj.sc.3101439 ◽

2003 ◽

Vol 41 (10) ◽

pp. 543-548 ◽

Cited By ~ 12

Author(s):

M V Küntscher ◽

D Erdmann ◽

W-H Boltze ◽

G Germann

Keyword(s):

Case Report ◽

Cervical Spine ◽

Spine Surgery ◽

Review Of The Literature ◽

Jejunal Graft ◽

Cervical Spine Surgery ◽

Free Jejunal Graft

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A novel device to simplify intraoperative radiographic visualization of the cervical spine by producing transient caudal shoulder displacement: a 2-center case series of 80 patients

Journal of Neurosurgery Spine ◽

10.3171/2013.9.spine11998 ◽

2013 ◽

Vol 19 (6) ◽

pp. 697-700 ◽

Cited By ~ 4

Author(s):

Christopher D. Witiw ◽

Jonathan S. Citow ◽

Howard J. Ginsberg ◽

Julian Spears ◽

Richard G. Perrin ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Cervical Vertebrae ◽

Spinal Instrumentation ◽

Case Series ◽

Cervical Spine Surgery ◽

Novel Device ◽

Before And After ◽

The Difference ◽

Intraoperative Localization

Object Intraoperative radiographic localization within the cervical spine can be a challenge because of the anatomical relation of the musculoskeletal structures of the pectoral girdle. On standard cross-table lateral radiographs, these structures can produce shadowing that obscure the anatomical features of the cervical vertebrae, particularly at the caudal levels. Surgical guidelines recommend accurate intraoperative localization as a means to reduce wrong-level spine surgery, and unobstructed visualization is needed for fluoroscopy-guided placement of spinal instrumentation. In this article, the authors describe and evaluate a novel device designed to provide transient intraoperative caudal displacement of the shoulders to improve and simplify radiographic visualization of the cervical spine. Methods A 2-center prospective study was conducted to evaluate the device. The study included a total of 80 patients undergoing cervical spine surgery. The device was evaluated in a cohort of 50 patients undergoing elective single-level anterior discectomy and fusion and also in a second cohort of 30 patients at an independent institution. The patients in this second cohort were undergoing a variety of cervical spine procedures for multiple indications and were included in the study to allow the authors to assess the effectiveness of the device in a general neurosurgical practice. After the patients were anesthetized and positioned, consecutive standard cross-table lateral radiographs or intraoperative fluoroscopic were obtained before and after use of the device. The images were compared in order to determine the difference in lowest vertebral level visible. Results There was an average difference in cervical spine visualization of +2.8 ± 0.9 vertebral levels in the first cohort, while in the second the improvement was +1.2 ± 0.7 levels (p < 0.0001 between cohorts, unpaired t-test). There was one complication, a minor shoulder abrasion, which required no specific management. Conclusions This device is safe and effective for increasing the radiographic visualization of the cervical spine for intraoperative localization.

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