scholarly journals Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ying-Chun Chen ◽  
Lin Zhang ◽  
Er-Nan Li ◽  
Li-Xiang Ding ◽  
Gen-Ai Zhang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Esophageal Perforation ◽  
Radical Neck Dissection ◽  
Titanium Implant ◽  
Anterior Cervical Discectomy ◽  
Antibiotic Administration ◽  
Cervical Discectomy ◽  
Cervical Infection ◽  
Unstable Cervical Spine ◽  
Degenerative Cervical Spine

Abstract Background Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. Case presentation Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. Conclusions This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

scholarly journals Variation in 90-Day Postoperative Costs Among Patients Undergoing Elective Anterior Cervical Discectomy and Fusion: Insights From the OPTUM Labs Data Warehouse (OLDW)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Mohammed A Alvi ◽  
Anshit Goyal ◽  
Yagiz U Yolcu ◽  
Stephanie Payne ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Data Warehouse ◽  
Anterior Cervical Discectomy ◽  
Medicare Advantage ◽  
Cervical Discectomy ◽  
Commercial Insurance ◽  
South Central ◽  
Degenerative Cervical Spine ◽  
Spine Disease ◽  
Degenerative Cervical Spine Disease

Abstract INTRODUCTION Anterior Cervical Discectomy and Fusion (ACDF) has been shown to be associated with high direct and associated costs. We aimed to identify factors associated with higher 90-day costs following elective ACDF for degenerative cervical spine disease among patients with commercial insurance and those on Medicare Advantage, using an administrative database. METHODS Optum Labs Data Warehouse (OLDH) was queried for patients undergoing an anterior cervical decompression and fusion (ACDF) for degenerative cervical spine disease. between 2012 and 2015. Geographic variations were evaluated as per U.S. Census Division. Patients were stratified by insurance status (commercial or Medicare advantage) and by the 9 US census regions. The primary outcome was all postoperative 90-d costs. RESULTS A total of 29 380 patients underwent an ACDF of which 86.7% patients had commercial insurance while 13.3% had Medicare Advantage. Regional 90-d adjusted mean costs per patient varied significantly between the 2 insurance groups, most notably for patients with commercial insurance undergoing ACDF ($70,765.17 for Mid-Atlantic to $29,364.02 for East South Central). Multivariable regression analyses revealed that the geographic region where procedure was performed, number of operated levels, number of readmissions and number of ED visits were significantly associated with higher costs. CONCLUSION There is significant regional variation in 90-d postoperative adjusted costs for patients on commercial and Medicare insurance undergoing elective ACDF. These analyses are important to help surgeons develop region-specific interventions to alleviate the cost burden for patients and assist policymakers in designing better risk-adjusted reimbursement policies for providers and hospitals.

3-Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease After Monosegmental Anterior Cervical Discectomy and Arthroplasty

Spine ◽  
2017 ◽  
Vol 42 (4) ◽  
pp. 224-231
Author(s):  
Steffen K. Fleck ◽  
Soenke Langner ◽  
Christian Rosenstengel ◽  
Rebecca Kessler ◽  
Marc Matthes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Anterior Cervical Discectomy ◽  
3 Tesla ◽  
Adjacent Level ◽  
Cervical Discectomy

scholarly journals Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis

2021 ◽  
Vol 50 (6) ◽  
pp. E6
Author(s):  
Stephen M. Bergin ◽  
Timothy Y. Wang ◽  
Christine Park ◽  
Shashank Rajkumar ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Bone Growth ◽  
Bone Matrix ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Cervical Spine Surgery ◽  
Single Level ◽  
Flexion Extension ◽  
Index Level ◽  
Instrumentation Failure

OBJECTIVE The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51–16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04–4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.

scholarly journals Outcome Study of Anterior Cervical Discectomy and Fusion with Lordotic Cage Insertion

2021 ◽  
Author(s):  
Nattawut Niljianskul
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Intervertebral Disk ◽  
Anterior Cervical Discectomy ◽  
P Value ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
Radiographic Outcomes ◽  
Disk Height

Objective: This study retrospectively evaluated the clinical and radiographic outcomes following the use of a lordotic cage in anterior cervical discectomy and fusion (ACDF).Material and Methods: All patients who underwent ACDF, at Vajira Hospital; between May 2017 and May 2020, were included in this study. Radiographic images were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), sagittal alignment (SA), and intervertebral disk height. The visual analog scale (VAS) for neck pain, and the Japanese Orthopaedic Association (JOA) score were reviewed as part of the patient’s medical records. Preoperative DLCA, SCA, GCA, SVA, SA, and intervertebral disk height measurements were compared with postoperative measurements at 1 year.Results: A total of 51 patients (88 disks), having undergone ACDF with lordotic cage insertion were included in this study. The initial curvature of the cervical spine was diagnosed as kyphosis in 30 (58.8%) patients, and as lordosis in 21 (41.2%) patients. There was significant improvement in the VAS, JOA, DLCA, SCA, GCA, SVA, SA, and intervertebral disk height after ACDF (p-value<0.050). In patients with preoperative kyphosis, the greatest changes were observed in the GCA (p-value=0.004).Conclusion: The use of a lordotic cage in ACDF improved both the clinical and radiographic outcomes of all postoperative parameters, regardless of the patient’s preoperative cervical spine curvature; although, patients with preoperative kyphosis had greater improvement in GCA.

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