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Takase H, Haze T, Yamamoto D, Inagaki N, Nitta M, Murata H, Yamamoto T. Network Meta-Analysis of C5 Palsy After Anterior Cervical Decompression of Three to Six Levels: Comparing Three Different Procedures. Spine (Phila Pa 1976) 2024; 49:188-196. [PMID: 37942814 DOI: 10.1097/brs.0000000000004865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Using a network meta-analysis (NMA), this study aimed to compare the risks of C5 palsy after three different procedures of anterior cervical decompression. SUMMARY OF BACKGROUND DATA C5 palsy is a well-known complication affecting the quality of life after anterior procedures. Due to the limited evidence on the various procedures available, we evaluate the basis for selection to prevent palsy and achieve maximal decompression in cases spanning 3-6 levels. MATERIALS AND METHODS We conducted a comprehensive search for C5 palsy and complications after 3representative procedures, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and their combination (hybrid), involving 3 to 6 intervertebral levels. The incidence of C5 palsy was compared using a NMA. RESULTS We identified 1655 patients in 11 studies who met inclusion criteria. Sixty-nine patients (4.2%) developed delayed C5 palsies. The incidences among ACDF, ACCF, and hybrid cases were 2.3% (16/684, 95% CI: 1.4% to 3.8%), 6.4% (39/613, 95% CI: 4.7% to 8.6%), and 3.9% (14/358, 95% CI: 2.3% to 6.5%), respectively ( P < 0.01). A NMA was performed for 15 pairwise comparisons across the 3 procedure arms: ACDF versus hybrid, 7/232 (3.0%) versus 11/234 (4.7%); hybrid versus ACCF, 14/301 (4.3%) versus 18/224 (8.0%); ACCF versus ACDF, 38/523 (7.8%) versus 16/619 (2.6%). Compared with ACDF, the risk of C5 palsy was significantly higher in ACCF (odds ratio: 2.72, 95% CI: 1.47 to 5.01), whereas ACDF versus hybrid did not significantly differ in risk (odds ratio: 1.56, 95% CI: 0.68 to 3.60). CONCLUSION We determined that ACCF was associated with a higher risk of postoperative C5 palsy than ACDF in cases spanning 3 to 6 intervertebral levels. If practicable, ACDF surgery may be an appropriate choice for cases requiring anterior decompression of 3 to 6 levels. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hajime Takase
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama
| | | | - Naoko Inagaki
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
| | - Manabu Nitta
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama
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Gazzeri R, Galarza M, Callovini G. Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion. Br J Neurosurg 2023; 37:1406-1409. [PMID: 33538190 DOI: 10.1080/02688697.2021.1881444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a fast, sutureless technique to repair anterior cervical dural tears. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of cervical degenerative diseases. Although uncommon, incidental durotomy with cerebrospinal fluid (CSF) leak during ACDF is a potentially serious complication. Yet, its technical management for the prevention of CSF leak is controversial. METHODS Between September 2012 and June 2018 we encountered seven cases (2 female/5 male) presenting with intraoperative CSF leaks secondary to incidental dural tears during ACDF surgery. All the cases were surgically treated using a topical fibrin sealant patch (TachoSil) with high adesive strength and fibrin glue (Tisseel). Intraoperative source of leakage, time to leakage control, quantity of Sealant Sponge used and postoperative complications were evaluated. RESULTS Dural tears were tipically the result of dissection of adherent posterior longitudinal ligament and/or calcified disc from the cervical dural sac to allow full decompression of the spinal cord. Effective repair of dural tear defined as cessation of CSF leak after topical sealant agents application was achieved no later than one minute in all cases. Evident clinical and/or radiological postoperative CSF leak was used to determine the patient's postoperative result. Postoperative CSF leak was not evident during a minimum 6 months follow up. CONCLUSIONS In the present study, we have reported our experience with a new sealing technique to manage CSF leaks from iatrogenic cervical dural lacerations. Tachosil tissue sealant patch is a rapid sutureless technique that may help in repairing introperatively incidental dural tears, thus reducing the risk of postoperative CSF leaks. To our knowledge, this is the first series to report the use of Tachosil adhesive sealant patch for the treatment of incidental dural tears during anterior cervical discectomy.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Neurosurgery, Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Giorgio Callovini
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Sejkorová A, Bolcha M, Beneš J, Kalhous J, Sameš M, Vachata P. Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial. Global Spine J 2023; 13:1635-1640. [PMID: 34586006 PMCID: PMC10448091 DOI: 10.1177/21925682211046895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Prospective randomized controlled trial. OBJECTIVES Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia. METHODS The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up. RESULTS A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG (P = .018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered. CONCLUSIONS Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia.
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Affiliation(s)
- Alena Sejkorová
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- Second Faculty of Medicine in Prague, Charles University in Prague, Prague, Czech Republic
| | - Martin Bolcha
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- The Faculty of Medicine in Pilsen, Department of Neurosurgery, University Hospital in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Jan Beneš
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J J. E. Purkyně University, Ústí nad Labem, Czech Republic
- Faculty of Medicine in Hradec Kralove, University Hospital, Charles University in Prague, Hradec Kralove, Czeck Republic
| | - Jiří Kalhous
- Faculty of Medicine in Hradec Kralove, University Hospital, Charles University in Prague, Hradec Kralove, Czeck Republic
- Department of Otorhinolaryngology, Head and Neck Surgery Department, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- The Faculty of Medicine in Pilsen, Department of Neurosurgery, University Hospital in Pilsen, Charles University in Prague, Prague, Czech Republic
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Tang L, Liu X, Lu Y, Liu Y, Yu J, Zhao J. Clinical and imaging outcomes of self-locking stand-alone cages and anterior cage-with-plate in three-level anterior cervical discectomy and fusion: a retrospective comparative study. J Orthop Surg Res 2023; 18:276. [PMID: 37020306 PMCID: PMC10074675 DOI: 10.1186/s13018-023-03726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion has been considered standard management for cervical myelopathy and radiculopathy. However, the option of using self-locking stand-alone cages or cage-with-plate in three-level anterior cervical discectomy and fusion still remains controversial. The aim of this study was to evaluate the clinical and imaging outcomes of the two procedures in multilevel anterior cervical discectomy and fusion. METHODS Sixty-seven patients who underwent three-level anterior cervical discectomy and fusion were enrolled in this study, of which 31 patients underwent surgery using self-locking stand-alone cages (group cage) and 36 patients using cage-with-plate (group plate). For the evaluation of clinical outcomes, modified Japanese Orthopedic Association scores, visual analogue scale for neck pain, neck disability index, Odom's criteria and dysphagia status were measured. Imaging outcomes were evaluated by cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height, range of motion, cage subsidence rate, fusion rate and adjacent segment degeneration. Statistical analyses were performed using the SPSS software (version 19.0). RESULTS Both groups showed improvement in modified Japanese Orthopedic Association scores, visual analogue scale for neck pain and neck disability index, after surgery, and there was no significant difference between the groups. The occurrence rate of dysphagia is significantly lower in the group cage compared with the group plate (p < 0.05). The postoperative cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height and cage subsidence rate in the group plate were significantly superior to that in the group cage (p < 0.05). However, the rate of adjacent segment degeneration was significantly lower in the group cage compared with the group plate (p < 0.05). Both groups showed no significant difference in terms of fusion rate (p > 0.05). CONCLUSIONS The self-locking stand-alone cages are effective, reliable and safe in anterior cervical discectomy and fusion for the treatment of cervical myelopathy and radiculopathy. Self-locking stand-alone cages showed a significantly lower rate of dysphagia and adjacent segment degeneration, while anterior cervical cage-with-plate could provide stronger postoperative stability and maintain better cervical spine alignment.
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Affiliation(s)
- Liang Tang
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Xiaoming Liu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Yanghu Lu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Yanbin Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, China
| | - Jiangming Yu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
| | - Jian Zhao
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Louie PK, Nemani VM, Leveque JCA. Anterior Cervical Corpectomy and Fusion for Degenerative Cervical Spondylotic Myelopathy: Case Presentation With Surgical Technique Demonstration and Review of Literature. Clin Spine Surg 2022; 35:440-446. [PMID: 36379070 DOI: 10.1097/bsd.0000000000001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
Anterior cervical corpectomy and fusion (ACCF) provides an extensive decompression and provides a large surface area for fusion in patients presenting with cervical spondylotic myelopathy. Unfortunately, this procedure is a more difficult spinal surgery to perform (compared with a traditional anterior cervical discectomy and fusion) and has a higher incidence of overall complications. In literature, ACCF has functional outcomes that seem clinically equivalent to those for multilevel anterior cervical discectomy and fusion, especially when contained to 1 vertebral body level, and in cases, for which both posterior and anterior procedures would be appropriate surgical options, may provide greater long-term clinical benefit than posterior fusion or laminoplasty. In this manuscript, we summarize the indications and outcomes following ACCF for degenerative cervical spondylotic myelopathy. We then describe a case presentation and associated surgical technique with a discussion of complication avoidance with this procedure.
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Affiliation(s)
- Philip K Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
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Miller A, Griepp DW, Miller C, Hamad M, De la Garza Ramos R, Murthy SG. The effectiveness of reducing endotracheal cuff pressure after retractor placement to decrease postoperative laryngeal dysfunction in anterior cervical surgery: a meta-analysis. J Neurosurg Spine 2022; 37:21-30. [PMID: 35171823 DOI: 10.3171/2021.11.spine211299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to determine if a consensus could be reached regarding the effectiveness of endotracheal tube cuff pressure (ETTCP) reduction after retractor placement in reducing postoperative laryngeal dysfunction after anterior cervical fusion surgery. METHODS A literature search of MEDLINE (PubMed), EMBASE, Cochrane Central, Google Scholar, and Scopus databases was performed. Quantitative analysis was performed on data from articles comparing groups of patients with either reduced or unadjusted ETTCP after retractor placement in the context of anterior cervical surgery. The incidence and severity of postoperative recurrent laryngeal nerve palsy (RLNP), dysphagia, and dysphonia were compared at several postsurgical time points, ranging from 24 hours to 3 months. Heterogeneity was assessed using the chi-square test, I2 statistics, and inverted funnel plots. A random-effects model was used to provide a conservative estimate of the level of effect. RESULTS Nine studies (7 randomized, 1 prospective, and 1 retrospective) were included in the analysis. A total of 1671 patients were included (1073 [64.2%] in the reduced ETTCP group and 598 [35.8%] in the unadjusted ETTCP group). In the reduced ETTCP group, the severity of dysphagia, measured by the Bazaz-Yoo system in 3 randomized studies at 24 hours and at 4-8 weeks, was significantly lower (24 hours [standardized mean difference: -1.83, p = 0.04] and 4-8 weeks [standardized mean difference: -0.40, p = 0.05]). At 24 hours, the odds of developing dysphonia were significantly lower (OR 0.51, p = 0.002). The odds of dysphagia (24 hours: OR 0.77, p = 0.24; 1 week: OR 0.70, p = 0.47; 12 weeks: OR 0.58, p = 0.20) were lower, although not significantly, in the reduced ETTCP group. The odds of a patient having RLNP were significantly lower at all time points (24 hours: OR 0.38, p = 0.01; 12 weeks: OR 0.26, p = 0.03) when 3 randomized and 2 observational studies were analyzed. A subgroup analysis using only randomized studies demonstrated a similar trend in odds of having RLNP, yet without statistical significance (24 hours: OR 0.79, p = 0.60). All other statistically significant findings persisted with removal of any observational data. CONCLUSIONS Based on the current best available evidence, reduction of ETTCP after retractor placement in anterior cervical surgery may be a protective measure to decrease the severity of dysphagia and the odds of developing RLNP or dysphonia.
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Affiliation(s)
- Aaron Miller
- 1New York Institute of Technology, Old Westbury, New York
| | | | - Chase Miller
- 2Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York; and
| | - Mousa Hamad
- 3Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Rafael De la Garza Ramos
- 3Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Saikiran G Murthy
- 3Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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Li YS, Tan ECH, Tsai YJ, Mandell MS, Huang SS, Chiang TY, Huang WC, Chang WK, Chu YC. A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial. Front Med (Lausanne) 2022; 9:920726. [PMID: 35847807 PMCID: PMC9276934 DOI: 10.3389/fmed.2022.920726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSurgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.MethodsEighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence of postoperative sore throat and dysphonia.ResultsThe incidence of pressure adjustment after surgical retraction was significantly lower in the tapered group than in the control group (13% vs. 48%; P = 0.001; relative risk reduction, 74%). The median [interquartile range (IQR)] cuff pressure (mm Hg) was significantly lower for the tapered cuff than for the control cuff before surgical retraction [9 (7–12) vs. 12 (10–15); P < 0.001] and after retraction [18 (15–23) vs. 25 (18–31); P = 0.007]. The median (IQR) postoperative dysphonia score assessed by a single speech-language pathologist was lower in the tapered group than in the control group [4 (3–6) vs. 5.5 (5–7); P = 0.008].ConclusionA tapered cuff tracheal tube decreased the need for the adjustment of cuff pressure after surgical retraction during anterior cervical spine surgery, thereby avoiding intraoperative pressure increase. It also has a better outcome in terms of dysphonia.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT04591769].
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Affiliation(s)
- Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei City, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yueh-Ju Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Mercedes Susan Mandell
- Department of Anesthesiology, University of Colorado, Aurora, CO, United States
- Department of Anesthesiology, McGovern Medical School, Memorial Hermann-Texas Medical Center, University of Texas Health, Houston, TX, United States
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ting-Yun Chiang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Ya-Chun Chu,
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Seok SY, Lee DH, Park SH, Lee HR, Cho JH, Hwang CJ, Lee CS. Laryngoscopic Screening Before Revision Anterior Cervical Spine Surgery: Is Vocal Cord Palsy a Relevant Factor in Deciding the Approach Direction? Clin Spine Surg 2022; 35:E292-E297. [PMID: 34670988 DOI: 10.1097/bsd.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES The aim was to evaluate the exact incidence of vocal cord palsy (VCP) caused by previous anterior cervical spine surgery (ACSS) and aid surgeons in deciding the approach direction in revision ACSS. SUMMARY OF BACKGROUND DATA The incidence of VCP detected by preoperative laryngoscopic screening before revision ACSS appeared to be much higher in previous reports than in our experience. MATERIALS AND METHODS We reviewed the data of 64 patients who underwent revision ACSS. Preoperative laryngoscopy was performed in all patients to detect VCP and/or structural abnormalities of the vocal cords. The patients' characteristics, laryngoscopy results, and symptoms before revision surgery that were potentially caused by previous recurrent laryngeal nerve injuries (voice change, foreign body sensation, and chronic aspiration) were recorded. RESULTS Laryngoscopy demonstrated no complete VCP or decreased vocal cord motility. Eleven patients (17.2%) showed vocal cord-related symptoms and 13 patients (20.3%) showed abnormal laryngoscopic findings without VCP. Four patients (6.2%) showed vocal cord-related symptoms and abnormal laryngoscopic findings simultaneously. At the initial operative level, no significant differences in vocal cord-related symptoms were observed between the upper and lower levels (C3-4-5 vs. C5-6-7). However, the frequency of vocal cord-related symptoms was significantly high at the larger number of levels (≥3 segments) (P=0.010). CONCLUSIONS In contrast to previous reports, this study demonstrated that VCP is rarely detected before revision ACSS. Therefore, deciding the approach direction with only vocal cord motility can be dangerous, and more attention is required in setting the approach direction in patients who show both vocal cord-related symptoms and abnormal laryngoscopic finding. In other cases, a contralateral approach which has a low risk of bilateral VCP could be utilized if necessary.
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Affiliation(s)
- Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Se Han Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggido, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Cengiz AB, Doruk E. Assessment of Acoustic Voice Parameters After Anterior Cervical Discectomy and Fusion. Cureus 2021; 13:e20611. [PMID: 35103187 PMCID: PMC8782208 DOI: 10.7759/cureus.20611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is a surgical treatment approach for cervical spine diseases. Alteration in voice quality is a commonly encountered concern after perilaryngeal neck surgeries. Vocal cord paralysis is a known complication of ACDF. In this study, we aimed to investigate the effect of ACDF on acoustic voice parameters and to compare ACDF with posterior cervical discectomy and fusion (PCDF). Methodology In this study, we investigated 52 patients admitted to the hospital with symptoms related to cervical spinal cord compression and underwent spine surgery in the Neurosurgery Clinic (26 underwent ACDF and 26 underwent PCDF). For standardization, 25 healthy age and gender-matched volunteers were evaluated as the control group. The voices of the patients were analyzed digitally preoperatively and at first and third months postoperatively. As acoustic parameters, jitter, shimmer, basal frequency, and normalized noise energy were recorded. All patients were examined preoperatively and postoperatively for laryngeal pathology and were asked to fill the Voice Handicap Index-10 (VHI-10). Results The changes in four of the five acoustic parameters from baseline to postoperative first-month assessment in the ACDF group were significant (p < 0.05). These parameters almost approached normal values in the analysis performed at three months. In the PCDF group, no significant differences were seen in the acoustic analysis of the patients in comparison to the preoperative and the first and third-month assessments. The VHI-10 values were not significantly different among the patients who underwent ACDF or PCDF or control patients at any postoperative time point. Conclusions Our study demonstrated that voice parameters in patients who underwent ACDF worsened significantly after the surgery compared with patients who underwent PCDF; however, these changes recovered within three months postoperatively. The possible causes for these findings include the retraction of the vagus and the recurrent laryngeal nerve, postoperative edema of strap muscles, intubation trauma to the vocal folds, and other laryngeal structures.
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Primary and Revision Anterior Cervical Discectomy and Fusion: A Study of Otolaryngologic Outcomes in a Large Cohort. Spine (Phila Pa 1976) 2021; 46:1677-1682. [PMID: 34818267 PMCID: PMC8613446 DOI: 10.1097/brs.0000000000004089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE To determine risk factors for postoperative otolaryngologic complications among patients who undergo primary and revision anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Swallowing and voice dysfunction are frequent postoperative complaints after ACDF surgery with a published incidence varying between 1.2% and 60%. A thorough understanding of the incidence and risk factors for these complications is needed. METHODS Electronic medical records of adults who underwent ACDF with predicted difficult surgical site exposure performed by two-surgeon approach between 2008 and 2018 were reviewed. Patients were categorized by primary or revision ACDF status and by the number of levels addressed during the operation. Associations with postoperative otolaryngologic symptoms were assessed using simple and multivariable logistic regression. RESULTS Participants included 718 adults with an average age of 55.8 years and 45% female sex. One hundred seventy-five patients (27%) underwent revision ACDF; ACDF status was unidentifiable for 74 patients. Seventy-nine cases (12%) involved one spinal level. New postoperative otolaryngologic symptoms among those who underwent primary and revision ACDF were 12.6% and 10.9% respectively. No evidence was found of an association between postoperative otolaryngologic symptoms and revision ACDF (OR, 0.84 [95% CI, 0.48-1.49]; P = 0.55), but evidence was found of an association with prior thyroidectomy (aOR, 3.8 [95% CI, 1.53-8.94], P = 0.0003). Significant evidence was found of increased odds for new postoperative dysphagia with increasing number of surgical levels (aOR, 1.5 [95% CI, 1.09-2.07]; P = 0.01). CONCLUSION Prior thyroidectomy and number of spinal levels addressed during ACDF were identified as risk factors for postoperative otolaryngologic complications including dysphagia. Revision ACDF was not associated with increased odds of postoperative otolaryngologic symptoms or dysphagia.Level of Evidence: 4.
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Black RJ, Novakovic D, Plit M, Miles A, MacDonald P, Madill C. Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis. J Heart Lung Transplant 2021; 40:1483-1494. [PMID: 34836605 DOI: 10.1016/j.healun.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Despite continued surgical advancements in the field of cardiothoracic transplantation, post-operative complications remain a burden for the patient and the multidisciplinary team. Lesser-known complications including swallowing disorders (dysphagia), and voice disorders (dysphonia), are now being reported. Such disorders are known to be associated with increased morbidity and mortality in other medical populations, however their etiology amongst the heart and lung transplant populations has received little attention in the literature. This paper explores the potential mechanisms of oropharyngeal dysphagia and dysphonia following transplantation and discusses optimal modalities of diagnostic evaluation and management. A greater understanding of the implications of swallowing and laryngeal dysfunction in the heart and lung transplant populations is important to expedite early diagnosis and management in order to optimize patient outcomes, minimize allograft injury and improve quality of life.
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Affiliation(s)
- Rebecca J Black
- Speech Pathology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Australia
| | | | | | - Peter MacDonald
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Catherine Madill
- Faculty of Medicine and Health, The University of Sydney, Australia
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Li Z, Liu H, Yang M, Zhang W. A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study. BMC Musculoskelet Disord 2021; 22:278. [PMID: 33722229 PMCID: PMC7962321 DOI: 10.1186/s12891-021-04150-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM. METHODS An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. RESULTS Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress. CONCLUSION Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.
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Affiliation(s)
- Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China. .,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China.
| | - Hui Liu
- Seventh Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Ming Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Wentao Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
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13
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Gowd AK, Vahidi NA, Magdycz WP, Zollinger PL, Carmouche JJ. Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2021; 15:12-17. [PMID: 33900952 DOI: 10.14444/8001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Injury to the recurrent laryngeal nerve (RLN) has been implicated as a common complication following anterior cervical discectomy and fusion (ACDF) surgery. The purpose of this study is to determine the true incidence of voice hoarseness and RLN palsy following ACDF surgery, to determine the reliability of symptoms in the diagnosis of RLN injury, and to evaluate factors related to the development of these symptoms. METHODS All patients undergoing elective (primary or secondary) ACDF surgery at a single institution consented to and enrolled in the present study. All approaches were through the left side. Enrolled patients received both preoperative and postoperative (within 1 month following surgery) laryngoscopy by a fellowship-trained ENT physician for evaluation of RLN function. Patients also responded as to whether they were experiencing postoperative symptoms of dysphagia, aspiration, and voice changes. RESULTS In total, 108 patients were included in this study. Mean age of the population was 59.2 ± 10.7 years and mean body mass index was 31.2 ± 7.1 kg/m2. Three patients had previously undergone a thyroidectomy, whereas 20 patients had undergone a previous ACDF. Average intubation time for ACDF surgery was 121.6 ± 38.5 minutes. After surgery and excluding patients who were experiencing preoperative symptoms, 19 patients (20.4%) complained of dysphagia, 2 patients (1.9%) complained of aspiration symptoms, and 5 patients (4.6%) complained of voice hoarseness. There was no incidence of vocal cord palsy from postoperative laryngoscopy. From multivariate analysis, endotracheal cuff pressure after retractor placement was correlated to postoperative voice hoarseness, dysphagia, and aspiration symptoms. CONCLUSIONS From the results of this prospective study, the RLN remained functional even a month after surgery despite several cases of postoperative dysphagia, aspiration, and voice changes. Endotracheal cuff pressure, number of vertebral levels, body mass index, and intubation time were important variables related to postoperative symptoms. CLINICAL RELEVANCE Voice hoarseness does not necessarily indicate recurrent laryngeal nerve injury after ACDF but may be caused by compressive forces on laryngeal tissue during retraction or intubation. Laryngoscopy should be performed in cases with high clinical suspicion. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Nima A Vahidi
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - William P Magdycz
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Pamela L Zollinger
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Jonathan J Carmouche
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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14
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Neuroanesthesiology Update. J Neurosurg Anesthesiol 2021; 33:107-136. [PMID: 33480638 DOI: 10.1097/ana.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022]
Abstract
This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as well as critically ill patients with neurological diseases. Broad topics include general perioperative neuroscientific considerations, stroke, traumatic brain injury, monitoring, anesthetic neurotoxicity, and perioperative disorders of cognitive function.
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15
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Anterior Cervical Decompression and C5 Palsy: A Systematic Review and Meta-analysis of Three Reconstructive Surgeries. Spine (Phila Pa 1976) 2020; 45:1587-1597. [PMID: 32756281 DOI: 10.1097/brs.0000000000003637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis were performed with the literature including the case of C5 palsy following anterior cervical decompression surgery. OBJECTIVE The aim of this study was to compare three reconstructive procedures of anterior cervical decompression, the incidences of delayed C5 palsy and other complications were assessed. SUMMARY OF BACKGROUND DATA Delayed C5 palsy is now a well-known complication after cervical decompression surgery. The etiology of C5 palsy has been studied, especially after posterior surgery. However, in anterior surgery there has been a lack of investigation due to procedure variation. Additionally, limited evidence exists regarding the risk of C5 palsy in surgical procedures. METHODS We performed an extensive literature search for C5 palsy and other complications with ACDF, ACCF, and their combination (Hybrid). Gross incidences of C5 palsy after these three procedures were compared, and specific superiorities (or inferiorities) were investigated via comparison of binary outcomes between two of three groups using odds ratios (OR). RESULTS Twenty-six studies met the inclusion criteria. A total of 3098 patients were included and 5.8% of those developed C5 palsy. Meta-analyses demonstrated that ACDF had a lower risk of palsy than ACCF (OR 0.36, 95% confidence interval [CI] 0.16-0.78), whereas ACDF versus Hybrid (OR 0.60, 95% CI 0.24-1.51) and Hybrid versus ACCF (OR 1.11, 95% CI 0.29-4.32) were not significantly different. Although these differences were not observed in shorter lesion subgroups, there were significant differences between the three procedures in longer lesion subgroups (P = 0.0005). Meta-analyses revealed that in longer lesions, ACDF had a significantly lower incidence than ACCF (OR 0.42, 95% CI 0.22-0.82). Additionally, Hybrid surgery was noninferior for palsy occurrence compared to ACCF, and suggested a trend for reduced rates of other complications compared to ACCF. CONCLUSION ACDF may yield better outcomes than Hybrid and ACCF. Furthermore, Hybrid may have advantages over ACCF in terms of surgical complications. LEVEL OF EVIDENCE 3.
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Alicandri-Ciufelli M, Fermi M, Molinari G, Cavazza Aggazzotti E, Billi AM, Giliberto G, Cavalleri F, Pavesi G, Presutti L. Anatomic and radiologic relationships of neck structures to cervical spine: implications for anterior surgical approaches. ACTA OTORHINOLARYNGOLOGICA ITALICA 2020; 40:248-253. [PMID: 33100335 PMCID: PMC7586192 DOI: 10.14639/0392-100x-n0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/16/2020] [Indexed: 11/24/2022]
Abstract
The position of the pharyngolaryngeal framework is very important in choosing the best surgical approach for cervical spine disease. The aim of the present paper is to investigate the position of the hyoid bone and cricoid cartilage in relation to the cervical spine. Moreover, the surgical implications for anterior transcervical approaches to the upper spine and the prevertebral space are discussed. To minimise complication rates and increase surgical effectiveness, the location and extent of the cervical spine disease should be evaluated in the context of the patient’s specific anatomy. A retrospective analysis of 100 cervical spine MRIs was conducted. Patients with diseases that could alter anatomic relationships of cervical structures were excluded. The mid-sagittal view of the hyoid and the inferior margin of the cricoid cartilage were projected perpendicularly to the anterior surface of the cervical vertebrae. The distance between these two landmarks was measured on the same view. The distribution of hyoid projections ranged between C2-C3 and C4-C5 intervertebral space, while the cricoid cartilage ranged between C4-C5 and C7-T1 intervertebral spaces. The mean distance between these two landmarks was 49.1 ± 7.7 mm, with statistically significant differences between males and females. The position of the cricoid cartilage significantly influenced the length of the pharyngolaryngeal framework, while the position of hyoid did not. A wide range of variability in the position of the hyoid bone and the cricoid cartilage in relation to cervical levels exists. This implies that an a priori association of a cervical level to neck structures at risk might be inaccurate. The use of these easily identifiable landmarks on pre-operative imaging may help to guide the choice among different anterior surgical approaches to cervical spine and reduce the risk of surgical complications.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy.,Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Matteo Fermi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - Giulia Molinari
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | | | - Anna Maria Billi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giuliano Giliberto
- Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Francesca Cavalleri
- Neuroradiology Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Giacomo Pavesi
- Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
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Thomas AM, Fahim DK, Gemechu JM. Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck. Diagnostics (Basel) 2020; 10:diagnostics10090670. [PMID: 32899604 PMCID: PMC7555279 DOI: 10.3390/diagnostics10090670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.
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Affiliation(s)
- Alison M. Thomas
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA; (A.M.T.); (D.K.F.)
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| | - Daniel K. Fahim
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA; (A.M.T.); (D.K.F.)
- Michigan Head & Spine Institute, Southfield, MI 48034, USA
| | - Jickssa M. Gemechu
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
- Correspondence: ; Tel.: +1-248-370-3667
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Oh LJ, Dibas M, Ghozy S, Mobbs R, Phan K, Faulkner H. Recurrent laryngeal nerve injury following single- and multiple-level anterior cervical discectomy and fusion: a meta-analysis. JOURNAL OF SPINE SURGERY 2020; 6:541-548. [PMID: 33102890 DOI: 10.21037/jss-20-508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Recurrent laryngeal nerve (RLN) palsy is a common and potentially debilitating complication of anterior cervical discectomy and fusion (ACDF). The relationship between the risk of RLN palsy and the number of operated levels remains unclear, and no previous studies address potential differences between short- and long-term RLN injury following ACDF. Methods Electronic searches of PubMed, Cochrane, ScienceDirect and Google Scholar were performed from database inception to June 2019. Relevant studies reporting the rate of RLN palsy for patients undergoing ACDF for cervical spine pathology were identified according to predetermined inclusion and exclusion criteria. Statistical analysis was performed using fixed effects and random effects modelling. I2 and Q statistics were used to explore heterogeneity. Results Five studies with a total of 3,514 patients were included in the meta-analysis. The incidence of RLN palsy was found to be 1.2%. There were no statistically significant differences in the rate of RLN palsy between multiple- and single-level ACDF [odds ratio (OR) 1.04; 95% CI: 0.56-1.95; P=0.891, I2=0%]. There were similarly no statistically significant differences in RLN palsy rates for multiple- and single-level ACDF when patients were stratified based on length of follow-up of less than or greater than 12 months. Conclusions This analysis suggests that there is no statistically significant association between the number of ACDF operative levels and the risk of short- or long-term RLN palsy.
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Affiliation(s)
- Lawrence J Oh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mahmoud Dibas
- Sulaiman Al Rajhi Colleges, College of Medicine, Al-Bukayriyah, Saudi Arabia
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Ralph Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - Harrison Faulkner
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Moreira A, Forrest E, Lee JC, Paul E, Yeung M, Grodski S, Serpell JW. Investigation of recurrent laryngeal palsy rates for potential associations during thyroidectomy. ANZ J Surg 2020; 90:1733-1737. [PMID: 32783252 DOI: 10.1111/ans.16166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are many clinical associations and potential mechanisms of injury resulting in recurrent laryngeal nerve palsy (RLNP) after thyroidectomy. One possible cause of RLNP is focal intralaryngeal compression of the recurrent laryngeal nerve (RLN), which may be associated with the tracheal tube (TT). Therefore, we examined current RLNP rates to investigate potential associations, including intralaryngeal, airway, anaesthetic and anthropometric factors. METHODS We analysed 1003 patients undergoing thyroid surgery at The Alfred from 2010 to 2017, who had anatomically intact RLNs at the conclusion of thyroidectomy. All included patients underwent pre- and post-operative flexible nasendoscopy. The primary outcome was RLNP rate. We analysed potential associated factors including age, sex, operative time, surgical indication, pathology, American Society of Anaesthesiologists Physical Status, Mallampati scores, body mass index, intubation grade, TT size and specimen weight. The independent risk factors were identified by logistic regression analysis. RESULTS Overall, RLNP occurred in 83 patients (8.3%) of which one was permanent (0.1%). On univariate analysis, RLNP was associated with male sex (P = 0.02), and duration of surgery (P = 0.002). On multivariate analysis, both male sex (P = 0.047) and duration of surgery (P = 0.04) remained significant. Further, factors postulated to cause intralaryngeal compression of the RLN, including TT size, body mass index, intubation grade and Mallampati score, were not significantly associated with RLNP. CONCLUSION Our study showed a RLNP rate of 8.3%, and associations with longer operative duration, and male sex. Potential intralaryngeal factors were not identified.
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Affiliation(s)
- Alayne Moreira
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Edward Forrest
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Meei Yeung
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Jonathan W Serpell
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Huschbeck A, Knoop M, Gahleitner A, Koch S, Schrom T, Stoffel M, Alfieri A, Dengler J. Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion - Prevalence and Risk Factors. J Neurol Surg A Cent Eur Neurosurg 2020; 81:508-512. [PMID: 32777828 DOI: 10.1055/s-0040-1710351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors. MATERIALS AND METHODS This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery. RESULTS 214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; p = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient's age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97). CONCLUSIONS In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics.
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Affiliation(s)
- Alina Huschbeck
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Michael Knoop
- Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Adrian Gahleitner
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany
| | - Stefan Koch
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Institute of Pathology, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Thomas Schrom
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Otorhinolaryngology, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Michael Stoffel
- Department of Neurosurgery, Helios Clinic Krefeld, Krefeld, Germany
| | - Alex Alfieri
- Department of Neurosurgery, Winterthur Cantonal Hospital, Wintherthur, Switzerland.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus, Senftenberg, The Brandenburg Medical School Theodor Fontane, and the University of Potsdam, Germany
| | - Julius Dengler
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
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Kamel AAF, Amin OAI, Hassan MAMM, Elmesallamy WAEA, Hassan EM. Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study. J Clin Monit Comput 2020; 35:869-875. [PMID: 32556843 DOI: 10.1007/s10877-020-00546-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
Prediction of vocal cord dysfunction is essential after anterior cervical spine surgeries. This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. Rigid laryngoscopy was the standard confirmatory tool. For postoperative vocal cord edema, the anterior ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 78.9% with PPV = 78.9% and NPV = 88.2% and the novel lateral ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 94.7% with PPV = 93.75% and NPP = 90%. While for paralysis, the anterior ultrasonography approach diagnostic sensitivity = 86.7%, specificity = 85.7% with PPV = 81.25% and NPV = 90% and the novel lateral ultrasonography approach diagnostic (sensitivity, specificity with PPV and NPP) = 100%. The diagnostic accuracy of the novel lateral approach was more correlated to rigid laryngoscopy (91.7% and 100%) compared to anterior approach for vocal cord edema and paralysis (83.3% and 80.6%). Overall incidence of vocal cord paralysis was 16.6%. Risk of vocal cord paralysis was statistically significant more in female, multiple disc herniation, lower and mixed disc levels, Langenbeck retractor, cage and plate and duration of surgery ≥ 1.5 h. Transcutaneous Laryngeal ultrasound is a valid comfortable tool for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries with superiority of the novel lateral over anterior approach.
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Affiliation(s)
| | | | | | | | - Elham Magdy Hassan
- Phoniatrics at Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt
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22
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Park JH, Lee SH, Kim ES, Eoh W. Analysis of postoperative dysphagia after anterior cervical decompression and fusion. Br J Neurosurg 2020; 34:457-462. [PMID: 32347130 DOI: 10.1080/02688697.2020.1757037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the incidence and risk factors of postoperative dysphagia after anterior cervical decompression and fusion (ACDF) in terms of demographic, procedural and anaesthetic perspectives.Materials and methods: Medical records and radiologic data of patients who underwent anterior cervical surgery performed by two surgeons in a single centre between January 2012 and December 2015 were retrospectively analysed. Patients with spinal tumours, infective spondylitis and traumatic cervical pathologies were excluded. Patients with preoperative dysphagia and previous history of anterior cervical surgery were also excluded. Finally, 127 patients were enrolled. Bazaz dysphagia score was used for the diagnosis of postoperative dysphagia.Results: The incidence of postoperative dysphagia was 10.2% at six weeks after ACDF. Nine patients showed mild dysphagia that fully recovered at three months after ACDF. Four patients showed moderate dysphagia that also recovered fully at six months after surgery. The incidence of postoperative dysphagia increased significantly in cases of C4 or C5 level involvements. Age, sex, hypertension, body mass index, postoperative soft tissue swelling, intubation difficulty and intubation tools were not significant risk factors of ACDF. Diabetes mellitus, two surgical levels, the use of plate, long anaesthetic and operative time and large intubation tube size were causative factors of postoperative dysphagia in multivariable analysis (p < 0.05).Conclusions: The incidence of postoperative dysphagia after ACDF was relatively low, and the prognosis was good.
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Affiliation(s)
- Jong-Hyeok Park
- Department of Neurosurgery, Incheon St. Mary Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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23
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Mesfin FB, Hoang S, Ortiz Torres M, Ngnitewe Massa'a R, Castillo R. Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion. Cureus 2020; 12:e6930. [PMID: 32190483 PMCID: PMC7067352 DOI: 10.7759/cureus.6930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective While enhanced recovery after surgery (ERAS) protocols are associated with shorter length of stay and improved outcomes in multiple surgical specialties, its application to spine surgery has been limited. Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a relative efficacy and safety profile that makes it suitable for the application of ERAS principles. Reviewing our outcomes and practice and incorporating evidence-based clinical studies, we propose the development of an ERAS pathway for ACDF. Methods This is a retrospective review of ACDF cases performed at a single institution by a single surgeon from 2014 to 2017. Primary outcome measures included length of stay, complications, and 30-day readmission rates. The 1- and 2-level and the 3- and 4-level groups were also each consolidated into a single cohort for comparison. A comprehensive review of evidence-based literature pertaining to ACDF was then performed. Best-practice recommendations derived from the literature were incorporated into the proposed ERAS protocol. Results In this series of 75 1-level, 77 2-level, 44 3-level and 20 4-level ACDF procedures, the average surgical time (minutes) was 68, 90, 118 and 141; length of stay (days) was 1, 1, 1.4, and 1.7; drain usage (%) was 1.3, 2.6, 13.6 and 10; and 30-day readmission rates (%) were 2.7, 3.9, 4.5, and 15, respectively. Combining the 1- and 2-level as a single group and 3- and 4-level as another cohort, the 3- and 4-level cohort had a significantly higher rate of drain usage and estimated blood loss (EBL) but there was not a difference in length-of-stay, complications or 30-day readmission rates. Conclusions Given the relative equivalent safety profile between 1- and 2-level as compared to 3- and 4-level ACDF, the proposed ERAS pathway can be applied to all patients, and not just restricted to 1-level or 2-level ACDF. Taking into account feasibility parameters as deduced from a review of institutional outcomes, this pathway can streamline same-day discharge and improve the patient experience. Its success will be predicated on an iterative improvement process deriving from optimal prospective outcome measurements.
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Affiliation(s)
| | - Stanley Hoang
- Neurosurgery, University of Missouri School of Medicine, Columbia, USA
| | | | | | - Raul Castillo
- Anesthesiology, University of Missouri Health Care and University of Missouri School of Medicine, Columbia, USA
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24
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Right- Versus Left-sided Exposures of the Recurrent Laryngeal Nerve and Considerations of Cervical Spinal Surgical Corridor: A Fresh-Cadaveric Surgical Anatomy of RLN Pertinent to Spine. Spine (Phila Pa 1976) 2020; 45:10-17. [PMID: 31415463 DOI: 10.1097/brs.0000000000003204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens which have not previously been reported. OBJECTIVE We aimed to perform surgically relevant exposures of the anterior cervical spine with particular attention to observing the potential vulnerabilities of the RLN on right and left. SUMMARY OF BACKGROUND DATA Vulnerability of the RLN in the anterior cervical spine approach on the right versus left is the subject of ongoing debate. Although most cadaveric studies focus on course variations, structural relations of RLN, they have been done in preserved (fixed) cadavers without relevance to the needs of spinal exposure. METHODS Twelve fresh undyed cadavers had extensive layer by layer dissections by 2 surgeons (one with extensive experience as anatomy dissector). Both sides were explored for vulnerability during cervical spinal procedures. Each dissection was carried out in a phased approach and deliberately explored beyond what can be afforded in live surgery to allow the reader to conceptualize a better view of the structures. RESULTS In all specimens, we consistently demonstrated that the right surgical corridor involved manipulation of the nerve and its branches especially below C5 to achieve optimum midline access: in the right corridor, the RLN is on its oblique course to the tracheoesophageal groove. On the left, RLN is already in the tracheoesophageal groove and out of the surgical field involving minimal direct mobilization of the nerve. CONCLUSION RLN surgical anatomy photographed here is novel in using fresh unprocessed cadaveric specimens which has previously not been reported.Right surgical corridor, below C5, involves retraction/manipulation of RLN for achieving optimum spinal midline access, highlighting potential surgical vulnerability of right RLN. LEVEL OF EVIDENCE 3.
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25
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Themistoklis KM, Korfias SI, Papasilekas TI, Boviatsis KA, Kokkoros AG, Spartalis ED, Mimidis GP, Sakas DE. Anterior Cervical Discectomy and Fusion combined with thyroid gland surgery, a tailored case and literature review. BMC Musculoskelet Disord 2019; 20:629. [PMID: 31881874 PMCID: PMC6935108 DOI: 10.1186/s12891-019-2997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Nowadays, Anterior Cervical Discectomy and Fusion (ACDF) is considered a routine procedure. However, unexpected difficulties do occasionally arise, especially when anterior neck pathologies or anatomical variations are encountered. In such cases, proactive thinking will allow surgeons to tailor appropriately their approach and eliminate surgical risks. Case presentation We present the case of a 50-year-old male patient suffering from left upper limb radiculopathy that underwent a C7-T1 ACDF combined with a hemithyroidectomy. Excision of the right thyroid lobe was offered to the patient because of a goiter found during the preoperative work-up. Furthermore, the hemithyroidectomy provided a wide surgical field so the ACDF performed without excreting excessive traction to the adjacent neck structures. Conclusions The patient had an uncomplicated post-operative. To our knowledge this is the first report of a planned hemithyroidectomy being carried out as the first step towards an ACDF procedure.
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Affiliation(s)
- Konstantinos M Themistoklis
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Ypsilantou 45-46, 10676, Athens, Greece.
| | - Stefanos I Korfias
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Ypsilantou 45-46, 10676, Athens, Greece
| | - Themistoklis I Papasilekas
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Ypsilantou 45-46, 10676, Athens, Greece
| | - Konstantinos A Boviatsis
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Ypsilantou 45-46, 10676, Athens, Greece
| | - Agis G Kokkoros
- Department of Neurosurgery, St George's Hospital, London, UK
| | - Eleftherios D Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Damianos E Sakas
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Ypsilantou 45-46, 10676, Athens, Greece
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26
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Right Versus Left Approach to Anterior Cervical Discectomy and Fusion: An Anatomic Versus Historic Debate. World Neurosurg 2019; 135:135-140. [PMID: 31857270 DOI: 10.1016/j.wneu.2019.12.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
The debate over the influence approach sidedness has on the risk of recurrent laryngeal nerve palsy (RLNP) following anterior cervical discectomy and fusion (ACDF) has its origins with the introduction of the procedure for radicular pain in the 1950s. The recurrent laryngeal nerves follow disparate courses in the lower neck secondary to differences in embryogenesis. Because of these differences, some authors believe a right-sided approach increases the risk of RLNP. However, modern surgical series have not shown a clear risk of RLNP with a right- versus left-sided approach. By looking at the historical context surrounding the introduction of ACDF, we propose the dogmatic view of an increased risk of RLNP with a right-sided approach likely arose from a combination of theoretical anatomic risk and the early surgical experience of a pioneer of the procedure.
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27
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Chin KR, Pencle FJR, Benny A, Seale JA. Platysma sparing approach to anterior cervical spine surgery: A less exposure surgery technique. J Orthop 2019; 16:559-562. [PMID: 31660023 DOI: 10.1016/j.jor.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/11/2019] [Accepted: 06/02/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Authors aim to demonstrate the surgical technique and outcomes of using a platysma sparing approach to anterior cervical spine surgery. Methods Medical records of 496 prospective patients, group 1 (259 patients) with an outpatient platysma muscle-sparing approach. Group 2 (237 patients) with inpatient standard muscle-splitting approach. Results Intergroup comparison showed statistical significant improvement in VAS neck and NDI scores p = 0.009 and p = 0.012 and surgical operative time and estimated blood loss, p = 0.003 and p = 0.006 respectively. Conclusion This anatomy sparing technique demonstrates a safe, effective and reproducible approach to cervical spine surgery which is a goal of less exposure surgery philosophy.
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Affiliation(s)
- Kingsley R Chin
- Herbert Wertheim College of Medicine, Florida International University, USA
- Charles E. Schmidt College of Medicine, Florida Atlantic University, USA
- University of Technology, Jamaica
- Less Exposure Surgical Specialists Institute (LESS Institute), USA
| | - Fabio J R Pencle
- University of Technology, Jamaica
- Less Exposure Surgery (LES) Society, USA
| | | | - Jason A Seale
- Less Exposure Surgical Specialists Institute (LESS Institute), USA
- Less Exposure Surgery (LES) Society, USA
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28
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Changes in Tracheal Tube Cuff Pressure and Recurrent Laryngeal Nerve Conductivity During Thyroid Surgery. World J Surg 2019; 44:328-333. [DOI: 10.1007/s00268-019-05185-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Lubelski D, Pennington Z, Sciubba DM, Theodore N, Bydon A. Horner Syndrome After Anterior Cervical Discectomy and Fusion: Case Series and Systematic Review. World Neurosurg 2019; 133:e68-e75. [PMID: 31465851 DOI: 10.1016/j.wneu.2019.08.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Horner syndrome is an infrequently seen complication of anterior cervical discectomy and fusion (ACDF). Multicenter studies have reported a very low incidence, less than 0.1%. OBJECTIVE To identify the incidence in, characteristics of, and postoperative course in patients in whom postoperative Horner syndrome developed after ACDF. METHODS We performed a retrospective review of all patients who experienced Horner syndrome after ACDF for cervical degenerative disease at a single tertiary care institution between 2017 and 2018. A systematic review was then performed to identify studies investigating prevalence, diagnosis, and treatment of postoperative Horner syndrome after ACDF. RESULTS Of 1116 patients at our institution who underwent ACDF, the incidence of Horner syndrome was 0.45%. C4/5 and C5/6 were the 2 most common surgical levels. The complication was noted to occur immediately after surgery, and at least partial improvement was identified in all patients an average 3.5 months after surgery (range, 10 days to 6 months). These findings were consistent with our systematic review of 21 studies that showed an incidence of 0.6% (range, 0.02% to 4.0%), the most common surgical level C5/6 (64%), and 82% of patients experiencing at least partial resolution of symptoms within 1 year (60.7% complete, 21.4% partial resolution). CONCLUSION Horner syndrome occurs in 0.6% of patients undergoing ACDF. Careful postoperative examination should reveal this complication, which may be underdiagnosed or underreported in larger multicenter case series. The majority of patients experience complete resolution of symptoms within 6 months to 1 year and can be treated conservatively and expectantly.
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Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zachary Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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30
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Mattioli F, Ghirelli M, Trebbi M, Silvestri M, Presutti L, Fermi M. Improvement of Swallowing Function After Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis: Our Experience. World Neurosurg 2019; 134:e29-e36. [PMID: 31470164 DOI: 10.1016/j.wneu.2019.08.124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the swallowing improvement in patients who underwent a transcervical prevascular retrovisceral approach for symptomatic cervical diffuse idiopathic skeletal hyperostosis (DISH), by means of the 10-item Eating Assessment Tool (EAT-10) questionnaire. METHODS Retrospective observational study of 21 patients treated with a transcervical anterior prevascular retrovisceral approach for symptomatic DISH with dysphagia as the primary symptom. All patients underwent videofluoroscopic study of swallowing before surgery and the EAT-10 questionnaire before and after the surgical procedure. RESULTS A statistically significant (P < 0.001) improvement in the postoperative EAT-10 score was reported. Sixteen out of 21 patients (76.2%) had their symptoms completely resolved, with an EAT-10 score less than 3. These results were not influenced by age and sex nor by presence of tracheostomy. The preoperative EAT-10 score was consistently related to postoperative outcome. Patients with mild and moderate dysphagia had better Δ in EAT-10 scores than patients with severe and very severe dysphagia (P = 0.02). CONCLUSIONS Surgical management seems to be effective in resolving swallowing disorders related to this disease in a consistent percentage of patients. This evidence is supported by the statistically significant improvement in EAT-10 scores after treatment. Moreover, it might be postulated that early intervention can guarantee a higher success rate because patients with severe and very severe dysphagia had significantly smaller improvement.
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Affiliation(s)
- Francesco Mattioli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Michael Ghirelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy.
| | - Marco Trebbi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Martina Silvestri
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Matteo Fermi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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31
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Lee CH, Son DW, Lee SH, Lee JS, Sung SK, Lee SW, Song GS. Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65-74 Years) and Middle-Old Patients (Over 75 Years). Neurospine 2019; 17:156-163. [PMID: 31284342 PMCID: PMC7136094 DOI: 10.14245/ns.1836072.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/20/2019] [Indexed: 12/23/2022] Open
Abstract
Objective Anterior cervical discectomy and fusion (ACDF) is the most commonly performed procedure for degenerative cervical spondylosis. Because of its relatively low invasiveness and surgical procedure, old age is not regarded as an exclusion criterion for ACDF. However, very few studies have been conducted on the radiological and clinical outcomes of ACDF in older patients. The purpose of this study was to evaluate the radiological and clinical outcomes of ACDF in older patients.
Methods We retrospectively analyzed 48 patients (> 65 years) who underwent ACDF from January 2011 to December 2015. We divided the patients into 2 groups: young-old age group (65–74 years) and middle-old age group (≥ 75 years). Cervical lateral radiographs taken in the neutral standing position were evaluated preoperatively (PRE), on postoperative day 7 (POST), and at the 1-year follow-up (F/U). The radiological parameters included cervical angle (CA: C2–7 Cobb angle), segmental angle, total intervertebral height, disc height, sagittal vertical axis (SVA), T1 slope (T1s), and range of cervical motion (extension CA minus flexion CA). Postoperative hospital days, comorbidities, complications, and clinical outcomes were also analyzed.
Results We analyzed data from 48 patients (group A: n = 30 patients, 46 segments, mean age, 68.60 ± 3.36 years; group B: n = 18 patients, 23 segments, mean age, 79.22 ± 2.63 years). The surgical levels were as follows: C3/4, 4; C4/5, 7; C5/6, 10; C6/7, 29; and C7/ T1, 6 levels, and there were no significant between-group differences in the distribution. There were no significant between-group differences in the fusion and subsidence rates (fusion rate: group A, 76.2%; group B, 71.4%; p = 0.732; subsidence rate: group A, 34.8%; group B, 26.1%; p = 0.587). There was no longitudinal trend in the repeated-measurements analysis of variance test of the 2 groups of the PRE, POST, and F/U data for each radiological parameter. According to the paired t-test, T1 slope (T1s), SVA, and CA did not differ preoperatively and postoperatively. There was no statistically significant difference in visual analogue scale scores (axial, arm), the Neck Disability Index, or Odom’s criteria between the 2 groups (p = 0.448, p = 0.357, and p = 0.913).
Conclusion There was no significant difference in radiological and clinical outcomes between young-old and middle-old patients. Middle-old age does not seem to be a limitation to ACDF, but larger-scale and longer-term studies are needed to confirm the findings of this study.
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Affiliation(s)
- Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
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Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2019; 44:E400-E407. [PMID: 30889144 DOI: 10.1097/brs.0000000000002865] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy. METHODS Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable. RESULTS Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007). CONCLUSION Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard. LEVEL OF EVIDENCE 3.
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Aguilar DD, Brara HS, Rahman S, Harris J, Prentice HA, Guppy KH. Exclusion criteria for dysphagia for outpatient single-level anterior cervical discectomy and fusion using inpatient data from a spine registry. Clin Neurol Neurosurg 2019; 180:28-33. [PMID: 30877898 DOI: 10.1016/j.clineuro.2019.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/06/2019] [Accepted: 03/10/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Reported incidence of dysphagia after ACDFs has been as high as 79%. There, however, have been no studies that have specifically looked at developing a criteria for reducing the incidence of dysphagia for outpatient ACDFs. The aim of this study was to determine the risks factors for significant dysphagia that will exclude patients from outpatient single-level anterior cervical discectomy and fusions (ACDFs). PATIENTS AND METHODS Using the Kaiser Permanente Spine registry database, between January 2009 and September 2013, we identified all inpatients (there were no outpatients) who underwent primary elective one-level ACDFs. A cohort of patients were identified with in-hospital length of stay (LOS) > 48 h in which the reason for continued admission was primarily significant dysphagia (DG). Patient's demographics and intraoperative data (ACDF levels (upper [C2-3, C3-4], middle [C4-5, C5-6], lower [C6-7, C7-T1]), and operative times (<100, 100-199, ≥ 200, minutes)) was used to determine risk factors for dysphagia. RESULTS We found 747 single-level ACDF cases with a cohort of 239 (32.0%) who met the criteria for dysphagia (DG) with > 48 h admission. The DG group and non-dysphagia group (NDG) had similar demographics. Diabetes was excluded from regression analysis due to the low frequency. Compared to the lower spine level (C5-6, C7-T1), the upper spine level (C2-3, C3-4) ACDF had a higher likelihood for dysphagia (OR = 2.23, 95% CI = 1.35-3.68, p = 0.0016); no difference was found for middle spine level (C4-5, C5-6) ACDF. CONCLUSION Single-level ACDF at the upper cervical spine (C2-3, C3-4) was found to be the only risk factor for dysphagia with LOS > 48 h based on inpatient data from a spine registry. Age, BMI category, gender, ASA classification, smoking, and operative time were not predictive factors. These findings should be used for excluding patients who undergo outpatient single-level ACDF surgery to reduce significant postoperative dysphagia.
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Affiliation(s)
- Daniel-Diaz Aguilar
- David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States
| | - Harsimran S Brara
- Department of Neurosurgery, Kaiser Permanente, 4867 W Sunset Blvd., Los Angeles, CA, 90027, United States
| | - Shayan Rahman
- Department of Neurosurgery, Kaiser Permanente, 4867 W Sunset Blvd., Los Angeles, CA, 90027, United States
| | - Jessica Harris
- Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, San Diego, CA, 92108, United States
| | - Heather A Prentice
- Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, San Diego, CA, 92108, United States
| | - Kern H Guppy
- Department of Neurosurgery, Kaiser Permanente Medical Group, 2025 Morse Ave., Sacramento, CA, 95825, United States.
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Quantitative Risk Factor Analysis of Postoperative Dysphagia After Anterior Cervical Discectomy and Fusion (ACDF) Using the Eating Assessment Tool-10 (EAT-10). Spine (Phila Pa 1976) 2019; 44:E82-E88. [PMID: 29965886 DOI: 10.1097/brs.0000000000002770] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE The aim of this study was to utilize the Eating Assessment Tool-10 (EAT-10) to quantitatively analyze risk factors contributing to dysphagia after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA ACDF is one of the most common procedures performed in the United States, with postoperative dysphagia rates ranging from 2% to 60%. The EAT-10 is a self-administered, symptom-specific 10-item clinical instrument to document dysphagia symptom severity and has demonstrated excellent internal consistency, test-retest reliability, and criterion-based validity. METHODS This study utilized a retrospective chart review of 163 patients from July 2013 to October 2017 who underwent ACDF at a single institution and prospectively completed EAT-10 surveys pre- and postoperatively. EAT-10 scores were collected preoperatively and at postoperative day 1, day 14, 1 month, 3 months, 6 months, and 12 months. Preselected risk factors were abstracted from the patients' chart. Univariate analyses were performed to identify candidate variables that correlated with abnormal EAT-10 scores at each time point. Multivariate logistic regression was then utilized to identify risk factors that were independently correlated with abnormal EAT-10 scores at each time point. RESULTS Female gender, younger patients, and increased operating room (OR) time was associated with increased rates of dysphagia in the early postoperative period. History of obstructive sleep apnea, history of asthma, increased American Society of Anesthesiologists (ASA) score, and a larger number of spinal levels included in the surgery were correlated with increased dysphagia in the later postoperative periods. CONCLUSION Dysphagia is common following ACDF. Factors associated with longer-term dysphagia seem to be more associated with pre-existing medical comorbidities. Understanding risk factors that correlate with increased rates of dysphagia has the potential to improve preoperative patient counseling and changes in operative management. LEVEL OF EVIDENCE 4.
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Schleicher P, Kobbe P, Kandziora F, Scholz M, Badke A, Brakopp F, Ekkerlein H, Gercek E, Hartensuer R, Hartung P, Jarvers JS, Matschke S, Morrison R, Müller CW, Pishnamaz M, Reinhold M, Schmeiser G, Schnake KJ, Stein G, Ullrich B, Weiss T, Zimmermann V. Treatment of Injuries to the Subaxial Cervical Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:25S-33S. [PMID: 30210958 PMCID: PMC6130109 DOI: 10.1177/2192568217745062] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Expert consensus. OBJECTIVES To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. METHODS This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. RESULTS Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a "dangerous mechanism of injury." Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-grade facet joint injuries or in the presence of vertebra-basilar symptoms. A0-, A1- and A2-injuries are treated conservatively, but have to be monitored for progressive kyphosis. A3 injuries are operated in the majority of cases. A4- and B- and C-type injuries are treated surgically. Most injuries can be treated with anterior plate stabilization and interbody support; A4 fractures need vertebral body replacement. In certain cases, additive or pure posterior instrumentation is needed. Usually, lateral mass screws suffice. A navigation system is advised for pedicle screws from C3 to C6. CONCLUSIONS These recommendations provide a framework for the treatment of subaxial cervical spine Injuries. They give advice about diagnostic measures and the therapeutic strategy.
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Affiliation(s)
- Philipp Schleicher
- Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt, Germany,Philipp Schleicher, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, DE-60389, Frankfurt am Main, Germany.
| | | | - Frank Kandziora
- Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt, Germany
| | - Matti Scholz
- Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt, Germany
| | | | - Florian Brakopp
- BG Klinikum Bergmannstrost Halle, Halle, Sachsen-Anhalt, Germany
| | | | - Erol Gercek
- Gemeinschaftsklinikum Mittelrhein, Koblenz, Rheinland-Pfalz, Germany
| | - Rene Hartensuer
- Universitatsklinikum Munster, Munster, Nordrhein-Westfalen, Germany
| | | | | | - Stefan Matschke
- BG Unfallklinik Ludwigshafen, Ludwigshafen, Rheinland-Pfalz, Germany
| | | | | | - Miguel Pishnamaz
- Universitatsklinikum Aachen, Aachen, Nordrhein-Westfalen, Germany
| | | | | | | | | | - Bernhard Ullrich
- BG Klinikum Bergmannstrost Halle, Halle, Sachsen-Anhalt, Germany
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Abstract
Context Cervical myelopathy occurs as a result of compression of the cervical spinal cord. Symptomatology includes, but is not limited to, pain, weakness, paresthesias, or gait/balance difficulties. Objective To present a two-decade experience with the management of cervical myelopathy. Methods Literature was reviewed to provide current guidelines for management as well as accompanying clinical presentations. Results Surgical decompression, if necessary, may be achieved from either an anterior, a posterior, or a combined anterior-posterior (AP) approach. The indications for each approach, as well as the surgical techniques, are described. Conclusion Several etiologies may lead to cord compression and cervical myelopathy. The best vector of approach with regard to anterior versus posterior surgical intervention is still under investigation. Regardless, management via surgical decompression has been demonstrated repeatedly to improve the CSM patients' quality of life.
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Affiliation(s)
- Robert F. Heary
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppasala, Sweden
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Zhou J, Li J, Lin H, Li X, Zhou X, Dong J. A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: Minimum 3-year assessment of radiographic and clinical outcomes. Clin Neurol Neurosurg 2018; 170:73-78. [PMID: 29734112 DOI: 10.1016/j.clineuro.2018.04.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/21/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The self-locking stand-alone cage has been clinically applied in treating cervical degenerative disc disease (CDDD). However, no long-term clinical and radiographic studies have been performed so far. This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone cages and cages with the anterior cervical plating system. PATIENTS AND METHODS A total of 98 consecutive patients were recruited in this study. Patients in the cage group were given stand-alone self-locking cages, and patients in the plate group were treated with cages and anterior plate fixation. The operative time, intraoperative blood loss and complications were recorded. Clinical outcomes were evaluated using the JOA scoring system, Neck Disability Index and Odom's criteria. The cervical lordosis, subsidence and cervical fusion status were assessed by X-ray and computed tomography. RESULTS The mean follow-up period was 39.7 months in the cage group and 42.2 months in the plate group. The operative time, intraoperative blood loss, postoperative dysphagia, sore throat and adjacent segment degeneration in the cage group were significantly less than those in the plate group (p < 0.05). All the patients in both groups achieved complete interbody fusion. Postoperative JOA and NDI scores in both groups were obviously improved compared with the preoperative ones. The postoperative cervical lordosis was effectively restored in both groups. CONCLUSIONS The self-locking stand-alone cage for ACDF could effectively restore the cervical physiological curvature, cause few complications, and lead to satisfactory outcomes. Therefore, it could be used as an effective and reliable treatment for the CDDD.
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Affiliation(s)
- Jian Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Juan Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xilei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaogang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Tasiou A, Giannis T, Brotis AG, Siasios I, Georgiadis I, Gatos H, Tsianaka E, Vagkopoulos K, Paterakis K, Fountas KN. Anterior cervical spine surgery-associated complications in a retrospective case-control study. JOURNAL OF SPINE SURGERY 2017; 3:444-459. [PMID: 29057356 DOI: 10.21037/jss.2017.08.03] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.
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Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Theofanis Giannis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Iordanis Georgiadis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Haralampos Gatos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Vagkopoulos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Comparison of Three Reconstructive Techniques in the Surgical Management of Patients With Four-Level Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2017; 42:E575-E583. [PMID: 27669040 DOI: 10.1097/brs.0000000000001907] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical series. OBJECTIVE To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of three reconstructive techniques after the anterior decompression of four-level cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA At present, the decision to treat multilevel CSM, especially four-level CSM, remains controversial. No one compares multilevel anterior cervical discectomy and fusion (mACDF), segmental anterior cervical corpectomy and fusion (sACCF) to multilevel anterior cervical discectomy and fusion with cage alone (mACDF-CA) in four-level constructs. METHODS Between July 2006 and February 2014, 97 consecutive patients with four-level CSM were enrolled in this study and divided into sACCF (n = 39) group, mACDF (n = 31) group, and mACDF-CA (n = 27) group. The study compared perioperative parameters, complication rates, clinical and radiologic parameters of three reconstructive techniques after the anterior decompression of four-level CSM. RESULTS The mACDF-CA group had the least bleeding and cost of index surgery compared with the sACCF group having the most bleeding and cost. Although significant pain relief and functional activity improvement have been achieved in the three groups at the final follow-up, there was no significant difference in the Japanese Orthopedic Association, SF-36 and NDI scores among the three groups (P >0.05). The mACDF group maintained the best cervical lordosis at the final follow-up, compared with the sACCF group maintained the worst cervical lordosis. Solid fusion was achieved in 87.1% of subjects in sACCF group, 90.3% in mACDF, and in 88.9% in mACDF-CA. The mACDF-CA group had a higher rate of subsidence and lower rate of dysphagia than other two groups. CONCLUSION mACDF-CA can be considered an effective and safe alternative procedure in the treatment of the four-level CSM. LEVEL OF EVIDENCE 4.
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Gokaslan ZL, Bydon M, De la Garza-Ramos R, Smith ZA, Hsu WK, Qureshi SA, Cho SK, Baird EO, Mroz TE, Fehlings M, Arnold PM, Riew KD. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study. Global Spine J 2017; 7:53S-57S. [PMID: 28451492 PMCID: PMC5400187 DOI: 10.1177/2192568216687547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Multicenter retrospective study. OBJECTIVES To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. METHODS A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patients were included if they underwent cervical spine surgery (levels from C2 to C7) between January 1, 2005 and December 31, 2011. Data were analyzed with regard to complication treatment and outcome. Cases were compared to a control group from the AOSpine CSM and CSM-I studies. RESULTS Three centers reported 19 cases of RLNP from a cohort of 1345 patients. The reported incidence of RLNP ranged from 0.6% to 2.9% between these 3 centers. Fifteen patients (79%) in the RLNP group were approached from the left side. Ten patients (52.6%) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). When examining outcomes, 73.7% (14/19) of cases resolved completely, 15.8% (3/19) resolved with residual effects, and in 10.5% (2/19) of cases this could not be determined. CONCLUSIONS In this multicenter study examining rare complications following cervical spine surgery, the risk of RLNP after cervical spine surgery ranged from 0.6% to 2.9% between centers. Though rare, it was found that 16% of patients may experience partial resolution with residual effects, and 74% resolve completely.
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Affiliation(s)
- Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA,The Miriam Hospital, Providence, RI, USA,Norman Prince Neurosciences Institute, Providence, RI, USA,Ziya L. Gokaslan, Norman Prince Neurosciences Institute, Rhode Island Hospital, 593 Eddy Street, APC-6, Providence, RI 02903, USA.
| | | | | | - Zachary A. Smith
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wellington K. Hsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan O. Baird
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - K. Daniel Riew
- Columbia University, New York, NY, USA,The Spine Hospital at NY-Presbyterian/Allen, New York, NY, USA
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Li Z, Wang H, Li L, Tang J, Ren D, Hou S. A new zero-profile, stand-alone Fidji cervical cage for the treatment of the single and multilevel cervical degenerative disc disease. J Clin Neurosci 2017; 41:115-122. [PMID: 28262396 DOI: 10.1016/j.jocn.2017.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 01/05/2023]
Abstract
To investigate the clinical and radiological results of the new zero-profile, stand-alone Fidji cervical cage to treat single- and multiple-level cervical DDD, and evaluate the safety and efficiency. Between October 2011 and July 2014, 72 consecutive patients (41 males and 31 females; mean age 50.9years [range, 33-68years]) with cervical DDD who underwent surgery and were followed for more than 2years were enrolled in this study (mean 31.1months, range 24-47months). The study compared clinical outcomes, radiologic parameters and complication rates. The SF-36, VAS, NDI, and JOA scores of all patients were improved significantly after surgery at any time point. (all p<0.05). The C2-C7 Cobb angle and the disc height index (DHI) of all patients were improved significantly after surgery at any time point (all p<0.05). From 3months after surgery to final follow-up the DHI showed a significant reduction comparing 1week after surgery (all p<0.05). The fusion rates were 91.7% (66/72) and the radiologic mean fusion time was 9.9months. Radiological evidence of adjacent segment degeneration (ASD) was observed in 4/41 patients (9.8%). Postoperative complications included epidural hematoma, hoarseness, dysphagia, axial neck pain, and subsidence. The zero-profile, stand-alone Fidji cervical cage for ACDF can be considered an effective, reliable and safe alternative procedure in the treatment of cervical DDD.
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Affiliation(s)
- Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China.
| | - Huadong Wang
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Li Li
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Jiaguang Tang
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Dongfeng Ren
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Shuxun Hou
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
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Lee JH, Cheng KL, Choi YJ, Baek JH. High-resolution Imaging of Neural Anatomy and Pathology of the Neck. Korean J Radiol 2017; 18:180-193. [PMID: 28096728 PMCID: PMC5240499 DOI: 10.3348/kjr.2017.18.1.180] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/10/2016] [Indexed: 11/15/2022] Open
Abstract
The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kai-Lung Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan.; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan.; Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Young Jun Choi
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Gowd A, Nazemi A, Carmouche J, Albert T, Behrend C. Indications for Direct Laryngoscopic Examination of Vocal Cord Function Prior to Anterior Cervical Surgery. Geriatr Orthop Surg Rehabil 2016; 8:54-63. [PMID: 28255513 PMCID: PMC5315243 DOI: 10.1177/2151458516681144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recurrent laryngeal nerve palsy (RLNP) is among the most common complications in both thyroid surgeries and anterior approaches to the cervical spine, having both a diverse etiology and presentation. Most bilateral paresis, with subsequent devastating impact on patients, are due to failure to recognize unilateral recurrent laryngeal nerve paralysis and, although rare, are entirely preventable with appropriate history and screening. Recurrent laryngeal nerve palsy has been shown to present asymptomatically in as high as 32% of cases, which yields limitations on exclusively screening with physical examination. Based on the available literature, diagnosis of unilateral RLNP is the critical factor in preventing the occurrence of bilateral RLNP as the surgeon may elect to operate on the injured side to prevent bilateral paresis. Analysis of incidence rates shows postoperative development of unilateral RLNP is 13.1 (95% confidence interval [CI]: 6.1-28.1) and 13.90 (95% CI: 6.6-29.3) times more likely in anterior spine and thyroid surgery, respectively, in comparison with intubation. Currently, there is no consensus on when to order a preoperative laryngoscopic examination prior to anterior cervical spine surgery. The importance of patient history should be emphasized, as it is the basis for indications of preoperative laryngoscopy. Efforts to minimize postoperative complications must be made, especially when considering the rising rate of cervical fusion. This study presents a systematic review of the literature defining key causes of RLNP, with a probability-based protocol to indicate direct laryngoscopy prior to anterior cervical surgery as a screening tool in the prevention of bilateral RLNP.
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Affiliation(s)
- Anirudh Gowd
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Anirudh Gowd, Musculoskeletal Education & Research Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Alireza Nazemi
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jonathan Carmouche
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Todd Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Caleb Behrend
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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44
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Rao RR, Ha J, Farley FA, Koopmann CF, Caird MS. Vocal Cord Paresis After Posterior Spinal Fusion to Treat Adolescent Idiopathic Scoliosis: A Case Report. JBJS Case Connect 2016; 6:e97. [PMID: 29252751 DOI: 10.2106/jbjs.cc.16.00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 15-year-old girl with adolescent idiopathic scoliosis with a 50° curve underwent posterior spinal fusion from T3 to T11. After discharge from the hospital, the patient reported dysphonia and dysphagia. Flexible nasendoscopy confirmed left vocal cord paresis. Stretch injury to the recurrent laryngeal nerve from the left T5 pedicle screw or intubation may have caused the vocal cord paresis. The pedicle screw was removed during revision surgery. Postsurgically, the patient demonstrated immediate and ultimately full recovery and no longer had any symptoms. CONCLUSION To our knowledge, this is the first case report of vocal cord paresis most likely caused by pedicle screw position after posterior spinal fusion.
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Affiliation(s)
| | - Jennifer Ha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Frances A Farley
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Charles F Koopmann
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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Abstract
The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.
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Affiliation(s)
- Justin A Iorio
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Patrick Reid
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Han Jo Kim
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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46
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Li Z, Zhao Y, Tang J, Ren D, Guo J, Wang H, Li L, Hou S. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1129-1139. [PMID: 27554353 DOI: 10.1007/s00586-016-4739-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/16/2016] [Accepted: 08/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, The People's Republic of China.
| | - Yantao Zhao
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Jiaguang Tang
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Dongfeng Ren
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Jidong Guo
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Huadong Wang
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Li Li
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
| | - Shuxun Hou
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
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47
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Zeng JH, Li XD, Deng L, Xiao Q. Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery. Clin Neurol Neurosurg 2016; 149:118-21. [PMID: 27513980 DOI: 10.1016/j.clineuro.2016.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors. CLINICAL MATERIALS AND METHODS Patients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital's patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively. RESULTS 45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (P<0.001). This association was not weakened in multiple logistic regression analysis (OR 2.348, 95% CI 1.467-3.659, P<0.001). CONCLUSION The incidence of early dysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor.
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Affiliation(s)
- Ji-Huan Zeng
- Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China
| | - Xiao-Dan Li
- School of Nursing, Jiangxi Health Vocational College, Nanchang, 330052, China
| | - Liang Deng
- Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China
| | - Qiang Xiao
- Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China.
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48
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Complications of Anterior and Posterior Cervical Spine Surgery. Asian Spine J 2016; 10:385-400. [PMID: 27114784 PMCID: PMC4843080 DOI: 10.4184/asj.2016.10.2.385] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/07/2015] [Accepted: 06/08/2015] [Indexed: 02/03/2023] Open
Abstract
Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achieved with meticulous preoperative analysis of the pathology, good patient selection for a specific procedure and careful execution of the surgery. Cervical spine surgery is usually effective in treating most pathologies and only a reasonable complication rate exists.
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49
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Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy. J Clin Neurosci 2015; 25:27-35. [PMID: 26677786 DOI: 10.1016/j.jocn.2015.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/08/2015] [Indexed: 01/23/2023]
Abstract
The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries.
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50
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Helseth Ø, Lied B, Halvorsen CM, Ekseth K, Helseth E. Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe. Neurosurgery 2015; 76:728-37; discussion 737-8. [DOI: 10.1227/neu.0000000000000746] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
There is an increasing demand for surgery of degenerative spinal disease. Limited healthcare resources draw attention to the need for cost-effective treatments. Outpatient surgery, when safe and feasible, is more cost effective than inpatient surgery.
OBJECTIVE:
To study types and rates of complications after outpatient lumbar and cervical spine decompressions.
METHODS:
Complications were recorded prospectively in 1449 (1073 lumbar, 376 cervical) outpatients undergoing microsurgical decompression for degenerative spinal disease at the private Oslofjord Clinic from 2008 to 2013.
RESULTS:
Surgical mortality was 0%. A total of 51 (3.5%) minor and major complications were recorded in 51 patients. Three (0.2%) patients had to be admitted to a hospital the day of surgery. Twenty-two (1.5%) patients were admitted to a hospital within 3 months due to surgery-related events. The encountered complications were postoperative hematoma (0.6%), neurological deterioration (0.3%), deep wound infection (0.9%), dural lesions with cerebrospinal fluid leakage (1.0%), persistent dysphagia (0.1%), persistent hoarseness (0.1%), and severe pain/headache (0.4%). All of the life-threatening hematomas were detected within 6 and 3 hours after cervical and lumbar surgery, respectively.
CONCLUSION:
This series of 1449 consecutive outpatient microsurgical spine decompressions adds to the growing literature in favor of outpatient spinal surgery in properly selected patients. In our study, 99.8% of the patients were successfully discharged either to their homes or to a hotel on the day of surgery. The overall complication rate was 3.5%, surgical mortality was 0%, and only 1.5% had to be admitted to a hospital within 3 months after surgery.
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Affiliation(s)
- Øystein Helseth
- Oslofjordklinikken, Sandvika, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bjarne Lied
- Oslofjordklinikken, Sandvika, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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