Anterior cervical corpectomy and fusion : Spinal cord compression caused by buckled ligamentum flavum

Complications of anterior cervical spine surgery: a systematic review of the literature

The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.

The ABC's of Spinal Decompression: Pearls and Technical Notes

OBJECTIVE

The foundation of spine surgery centers on the proper identification, decompression, and stabilization of bony and neural elements. We describe easily reproducible and reliable methods for optimal decompression and release of neural structures to alleviate symptoms and improve patients' quality of life.

METHODS

Multiple spinal decompression techniques were described in procedures for which the goal of surgery was decompression alone or decompression and fusion. Eight fundamental techniques were described: inverted U-cut, J-cut, T-cut, L-cut, Z-cut, I-track cuts, C-cut, and O-cut.

RESULTS

These foundational cuts may be combined, as needed, to develop an individually tailored approach to the patient's pathology.

CONCLUSIONS

After properly identifying the anatomic structures, each of these techniques provides a consistent, reproducible, and efficient means to decompress the spine under various circumstances. These techniques provide surgical trainees with a framework for approaching surgical decompression.

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

BACKGROUND

Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases.

METHODS

We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years. Surgical indication was multilevel cervical degenerative myelopathy and radiculopathy in 72 (85%) patients, multilevel cervical spondylodiscitis in four (5%), complex traumatic cervical fractures in four (5%), metastatic cervical spine tumor in two (2%), and ossification of the posterior longitudinal ligament in three (3%) patients.

RESULTS

There were no severe intraoperative complications such as spinal cord or vertebral artery injury or dissection. Seventy-three patients had four, 10 patients had five, and two patients had six anterior cervical level fixations. The visual analog scale (VAS) and Japanese Orthopedic Association (mJOA) scale scores improved (6.9 to 1.3 (p < 0.001) and 13.9 to 16.5 (p < 0.001), respectively). The Cobb angle increased from 5.7° to 17.6° postoperatively (p < 0.001). Secondary posterior fixation was necessary in three cases due to pseudarthrosis.

CONCLUSION

The anterior approach appears to be optimal for ventral compressive pathology and lordosis restoration to the cervical spine. Limitations of multiple level decompression and fixation included increasing pseudoarthrosis rates, especially after corpectomy, and increasing fused level numbers.