The Impact of Metabolic Syndrome on 30-Day Outcomes Following Elective Anterior Cervical Discectomy and Fusions

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

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Impact of local steroid application on dysphagia following an anterior cervical discectomy and fusion: results of a prospective, randomized single-blind trial

Journal of Neurosurgery Spine ◽

10.3171/2017.11.spine17819 ◽

2018 ◽

Vol 29 (1) ◽

pp. 10-17 ◽

Cited By ~ 7

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Ankur S. Narain ◽

Fady Y. Hijji ◽

Daniel D. Bohl ◽

...

Keyword(s):

Controlled Trial ◽

Anterior Cervical Discectomy ◽

Retropharyngeal Abscess ◽

Cervical Discectomy ◽

Air Index ◽

Estimated Blood Loss ◽

Patient Reported ◽

Chi Square Analysis ◽

The Impact ◽

Single Blind

OBJECTIVEIntraoperative local steroid application has been theorized to reduce swelling and improve swallowing in the immediate period following anterior cervical discectomy and fusion (ACDF). Therefore, the purpose of this study was to quantify the impact of intraoperative local steroid application on patient-reported swallow function and swelling after ACDF.METHODSA prospective, randomized single-blind controlled trial was conducted. A priori power analysis determined that 104 subjects were needed to detect an 8-point difference in the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire score. One hundred four patients undergoing 1- to 3-level ACDF procedures for degenerative spinal pathology were randomized to Depo-Medrol (DEPO) or no Depo-Medrol (NODEPO) cohorts. Prior to surgical closure, patients received 1 ml of either Depo-Medrol (DEPO) or saline (NODEPO) applied to a Gelfoam carrier at the surgical site. Patients were blinded to the application of steroid or saline following surgery. The SWAL-QOL questionnaire was administered both pre- and postoperatively. A ratio of the prevertebral swelling distance to the anteroposterior diameter of each vertebral body level was calculated at the involved levels ± 1 level by using pre- and postoperative lateral radiographs. The ratios of all levels were averaged and multiplied by 100 to obtain a swelling index. An air index was calculated in the same manner but using the tracheal air window diameter in place of the prevertebral swelling distance. Statistical analysis was performed using the Student t-test and chi-square analysis. Statistical significance was set at p < 0.05.RESULTSOf the 104 patients, 55 (52.9%) were randomized to the DEPO cohort and 49 (47.1%) to the NODEPO group. No differences in baseline patient demographics or preoperative characteristics were demonstrated between the two cohorts. Similarly, estimated blood loss and length of hospitalization did not differ between the cohorts. Neither was there a difference in the mean change in the scaled total SWAL-QOL score, swelling index, and air index between the groups at any time point. Furthermore, no complications were observed in either group (retropharyngeal abscess or esophageal perforation).CONCLUSIONSThe results of this prospective, randomized single-blind study did not demonstrate an impact of local intraoperative steroid application on patient-reported swallowing function or swelling following ACDF. Neither did the administration of Depo-Medrol lead to an earlier hospital discharge than that in the NODEPO cohort. These results suggest that intraoperative local steroid administration may not provide an additional benefit to patients undergoing ACDF procedures.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: Class I.Clinical trial registration no.: NCT03311425 (clinicaltrials.gov)

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The Impact of Local Steroid Application on Dysphagia following an Anterior Cervical Discectomy and Fusion: Preliminary Results of a Prospectively, Randomized, Single Blind Trial

The Spine Journal ◽

10.1016/j.spinee.2016.07.116 ◽

2016 ◽

Vol 16 (10) ◽

pp. S205-S206

Author(s):

Dustin H. Massel ◽

Benjamin Mayo ◽

Junyoung Ahn ◽

Daniel D. Bohl ◽

Philip Louie ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Blind Trial ◽

Preliminary Results ◽

The Impact ◽

Single Blind ◽

Single Blind Trial

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Journal of Speech Language and Hearing Research ◽

10.1044/2016_jslhr-s-16-0091 ◽

2017 ◽

Vol 60 (4) ◽

pp. 785-793 ◽

Cited By ~ 6

Author(s):

Lydia Muss ◽

Janina Wilmskoetter ◽

Kerstin Richter ◽

Constanze Fix ◽

Soenke Stanschus ◽

...

Keyword(s):

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Anterior Cervical Discectomy ◽

Future Research ◽

Swallowing Function ◽

Pharyngeal Wall ◽

Cervical Discectomy ◽

Functional Measures ◽

Posterior Pharyngeal Wall Thickness ◽

The Impact

Purpose The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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The Impact Plate Application on the Sagittal Plane Correction after Anterior Cervical Discectomy and Fusion Compared to Stand Alone Cage.

Egyptian Spine Journal ◽

10.21608/esj.2020.30783.1136 ◽

2020 ◽

Vol 36 (1) ◽

pp. 14-23

Author(s):

Abduljabbar Alhammoud

Keyword(s):

Sagittal Plane ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Impact Plate ◽

The Impact

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The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

Spine ◽

10.1097/brs.0000000000004127 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Emily K. Chapman ◽

Tahera Doctor ◽

Jonathan S. Gal ◽

William H. Shuman ◽

Sean N. Neifert ◽

...

Keyword(s):

Length Of Stay ◽

Cost Of Care ◽

Anterior Cervical Discectomy ◽

Elective Admission ◽

Cervical Discectomy ◽

The Impact

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Chronic Obstructive Pulmonary Disease Is an Independent Predictor for 30-Day Complications and Readmissions Following 1- to 2-Level Anterior Cervical Discectomy and Fusion

Global Spine Journal ◽

10.1177/2192568218794170 ◽

2018 ◽

Vol 9 (3) ◽

pp. 298-302 ◽

Cited By ~ 3

Author(s):

Azeem Tariq Malik ◽

Nikhil Jain ◽

Jeffery Kim ◽

Safdar N. Khan ◽

Elizabeth Yu

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Anterior Cervical Discectomy ◽

Prior History ◽

Chronic Obstructive ◽

Improvement Program ◽

Obstructive Pulmonary Disease ◽

Cervical Discectomy ◽

Cervical Spine Surgery ◽

The Impact

Study Design: Retrospective cohort. Objectives: To study evidence to assess the impact of chronic obstructive pulmonary disease (COPD) on 30-day outcomes following 1- to 2-level anterior cervical discectomy and fusion (ACDF). Methods: The 2015-2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using Current Procedural Terminology (CPT) codes 22 551 (single-level) and 22 552 (additional level). Patients undergoing disc arthroplasty, multilevel (>2) fusion, posterior cervical spine surgery, and patients with fracture, tumor, and/or infection were excluded. Results: Out of 14 835 patients undergoing an elective 1- to 2-level ACDF, 649 (4.4%) had a diagnosis of COPD at the time of the surgery. Following adjusted logistic regression analysis, prior history of COPD was significantly associated with a longer length of stay (odds ratio [OR] 1.25 [95% confidence interval (CI0 1.04-1.52]; P = .019), superficial surgical site infection (OR 2.68 [95% CI 1.06-6.80]; P = .038), discharge destination other than home (OR 1.49 [95% CI 1.05-2.12]; P = .026), pneumonia (OR 4.37 [95% CI 2.42-7.88]; P < .001), ventilator use >48 hours (OR 5.34 [95% CI 1.88-15.15]; P = .002), unplanned reintubation (OR 3.36 [1.48-7.62]; P = .004), and 30-day readmissions (OR 1.69 [95% CI 1.20-2.38]; P = .003). Conclusions: The findings of this study show that COPD patients are more likely to have postoperative complications and 30-day readmissions, despite elective ACDF itself being a low-risk surgery in general. Results show that majority of the complications were pulmonary in nature, further stressing the need for accurate medical optimization following surgery in these patients.

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The Impact of Workerʼs Compensation Claims on Outcomes and Costs Following an Anterior Cervical Discectomy and Fusion

Spine ◽

10.1097/brs.0000000000000873 ◽

2015 ◽

Vol 40 (12) ◽

pp. 948-953 ◽

Cited By ~ 7

Author(s):

Ehsan Tabaraee ◽

Junyoung Ahn ◽

Daniel D. Bohl ◽

Islam M. Elboghdady ◽

Khaled Aboushaala ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Compensation Claims ◽

The Impact

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Assessment of spino cranial angle of cervical spine sagittal balance system after multi-level anterior cervical discectomy and fusion

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02353-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zheng Wang ◽

Zhi-Wei Wang ◽

Xi-Wen Fan ◽

Xian-Da Gao ◽

Wen-Yuan Ding ◽

...

Keyword(s):

Quality Of Life ◽

Cervical Spine ◽

Sagittal Balance ◽

Anterior Cervical Discectomy ◽

Operating Characteristics ◽

Cervical Discectomy ◽

Multi Level ◽

The Impact

Abstract Background To analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores. Material and methods In total, 49 patients following multi-level ACDF for multi-level cervical spondylotic myelopathy (MCSM) with more than 2 years follow-up period were enrolled. Radiographic data including SCA were measured. Receiver operating characteristics (ROC) curve analysis was applied to confirm the optimal cut-off values of SCA for predicting sagittal balance. Patients were divided into two groups on the basis of the cut-off value of preoperative SCA. Correlation coefficients were analyzed between SCA and HRQOL scores. Results Optimal cut-off values for predicting sagittal balance was SCA of 88.6°. Patients with higher SCA, no matter preoperatively, postoperatively and at follow-up, got lower T1-Slope (T1s), C2–C7 lordosis angle (CA) and higher △SCA (pre vs post: p = 0.036, pre vs F/U: p = 0.022). Simultaneously, pre-SCA, post-SCA, and F/U-SCA in the high SCA group were positively correlated with the pre-NDI, post-NDI, and F/U-NDI scores respectively (pre: p < 0.001, post: p = 0.015, F/U: p = 0.003). However, no correlation was performed in the low SCA group. Conclusion An excessive SCA can be considered to cause poorer clinical outcomes at preoperative and better correction after surgery. The SCA could be used as a new reference value to determine sagittal balance parameters of the cervical spine and to assess the quality of life.

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