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

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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Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery

10.21203/rs.3.rs-15465/v1 ◽

2020 ◽

Author(s):

Xiao-feng Zhao ◽

Xiang-dong Lu ◽

Yi-bo Zhao ◽

De-tai Qi ◽

Wen-xuan Wang ◽

...

Keyword(s):

Cervical Spine ◽

Blood Loss ◽

Internal Fixation ◽

Cobb Angle ◽

Clinical Efficacy ◽

Spine Surgery ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Cervical Surgery ◽

Plate System

Abstract BACKGROUND To observed and evaluated the clinical efficacy of a new type cervical anterior screw plate system development for anterior cervical surgery. Methods 27 patients with cervical spine disease treated with new PRUNUS nail plate internal fixation were selected as observation group, and 29 patients treated with conventional cervical anterior screw fixation were selected as the control group. Cervical stability, internal fixation position and bone graft fusion were evaluated according to imaging data. The operative time, intraoperative blood loss, cervical Cobb angle, VAS scores, and JOA scores were compared between the two groups. Spinal function scores and neurological improvement rates were used to evaluate the clinical efficacy of the new PRUNUS spine plate. Results There were statistical differences in operation time and blood loss between the two groups (P<0.05). The difference in Cobb angle, JOA score and improvement rate, VAS score before and after surgery in two groups were statistically significant (P<0.05), but no significant differences between two groups (P>0.05). Conclusion The new PRUNUS spine plate system can be applied to the anterior cervical spine surgery, and its clinical efficacy was similar to the traditional cervical anterior plate. But PRUNUS simplified the operation process, especially for the osteoporosis patients.

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Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature

Global Spine Journal ◽

10.1177/21925682211005737 ◽

2021 ◽

pp. 219256822110057

Author(s):

Lucia Moletta ◽

Elisa Sefora Pierobon ◽

Renato Salvador ◽

Francesco Volpin ◽

Francesco Massimiliano Finocchiaro ◽

...

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Spine Surgery ◽

Esophageal Perforation ◽

English Literature ◽

Case Series ◽

Review Of The Literature ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Fixation Devices

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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Respiratory Compromise After Anterior Cervical Spine Surgery: Incidence, Subsequent Complications, and Independent Predictors

Global Spine Journal ◽

10.1177/2192568220984469 ◽

2021 ◽

pp. 219256822098446

Author(s):

Venkat Boddapati ◽

Nathan J. Lee ◽

Justin Mathew ◽

Michael B. Held ◽

Joel R. Peterson ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Case Reports ◽

Patient Characteristics ◽

Patient Specific ◽

Bivariate Analysis ◽

Respiratory Compromise ◽

Cervical Spine Surgery ◽

Operative Duration ◽

Anterior Cervical Spine Surgery

Study design: Retrospective cohort study. Objective: Respiratory compromise (RC) is a rare but catastrophic complication of anterior cervical spine surgery (ACSS) commonly due to compressive fluid collections or generalized soft tissue swelling in the cervical spine. Established risk factors include operative duration, size of surgical exposure, myelopathy, among others. The purpose of this current study is to identify the incidence and clinical course of patients who develop RC, and identify independent predictors of RC in patients undergoing ACSS for cervical spondylosis. Methods: A large, prospectively-collected registry was used to identify patients undergoing ACSS for spondylosis. Patients with posterior cervical procedures were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate analysis was employed to compare postoperative complications and identify independent predictors of RC. Results: 298 of 52,270 patients developed RC (incidence 0.57%). Patients who developed RC had high rates of 30-day mortality (11.7%) and morbidity (75.8%), with unplanned reoperation and pneumonia the most common. The most common reason for reoperations were hematoma evacuation and tracheostomy. Independent patient-specific factors predictive of RC included increasing patient age, male gender, comorbidities such as chronic cardiac and respiratory disease, preoperative myelopathy, prolonged operative duration, and 2-level ACCFs. Conclusion: This is among the largest cohorts of patients to develop RC after ACSS identified to-date and validates a range of independent predictors, many previously only described in case reports. These results are useful for taking preventive measures, identifying high risk patients for preoperative risk stratification, and for surgical co-management discussions with the anesthesiology team.

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Return-to-active-duty rates after anterior cervical spine surgery in military pilots

Neurosurgical FOCUS ◽

10.3171/2018.9.focus18380 ◽

2018 ◽

Vol 45 (6) ◽

pp. E10

Author(s):

Charles A. Miller ◽

Jason H. Boulter ◽

Daniel J. Coughlin ◽

Michael K. Rosner ◽

Chris J. Neal ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Cervical Spondylosis ◽

Active Duty ◽

Disc Replacement ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Us Military ◽

Cervical Surgery ◽

Military Pilots

OBJECTIVESymptomatic cervical spondylosis with or without radiculopathy can ground an active-duty military pilot if left untreated. Surgically treated cervical spondylosis may be a waiverable condition and allow return to flying status, but a waiver is based on expert opinion and not on recent published data. Previous studies on rates of return to active duty status following anterior cervical spine surgery have not differentiated these rates among military specialty occupations. No studies to date have documented the successful return of US military active-duty pilots who have undergone anterior cervical spine surgery with cervical fusion, disc replacement, or a combination of the two. The aim of this study was to identify the rate of return to an active duty flight status among US military pilots who had undergone anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) for symptomatic cervical spondylosis.METHODSThe authors performed a single-center retrospective review of all active duty pilots who had undergone either ACDF or TDR at a military hospital between January 2010 and June 2017. Descriptive statistics were calculated for both groups to evaluate demographics with specific attention to preoperative flight stats, days to recommended clearance by neurosurgery, and days to return to active duty flight status.RESULTSAuthors identified a total of 812 cases of anterior cervical surgery performed between January 1, 2010, and June 1, 2017, among active duty, reserves, dependents, and Department of Defense/Veterans Affairs patients. There were 581 ACDFs and 231 TDRs. After screening for military occupation and active duty status, there were a total of 22 active duty pilots, among whom were 4 ACDFs, 17 TDRs, and 2 hybrid constructs. One patient required a second surgery. Six (27.3%) of the 22 pilots were nearing the end of their career and electively retired within a year of surgery. Of the remaining 16 pilots, 11 (68.8%) returned to active duty flying status. The average time to be released by the neurosurgeon was 128 days, and the time to return to flying was 287 days. The average follow-up period was 12.3 months.CONCLUSIONSAdhering to military service-specific waiver guidelines, military pilots may return to active duty flight status after undergoing ACDF or TDR for symptomatic cervical spondylosis.

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