Primary and Revision Anterior Cervical Discectomy and Fusion: A Study of Otolaryngologic Outcomes in a Large Cohort.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Dec 2021
15 Dec 2021
Historique:
entrez:
24
11
2021
pubmed:
25
11
2021
medline:
27
11
2021
Statut:
ppublish
Résumé
Retrospective chart review. To determine risk factors for postoperative otolaryngologic complications among patients who undergo primary and revision anterior cervical discectomy and fusion (ACDF). 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. 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. 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). 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.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective chart review.
OBJECTIVE
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
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 34818267
doi: 10.1097/BRS.0000000000004089
pii: 00007632-202112150-00006
pmc: PMC8613446
mid: NIHMS1695652
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1677-1682Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002384
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Buttermann GR. Anterior cervical discectomy and fusion outcomes over 10 years. Spine (Phila Pa 1976) 2018; 43:207–214.
Nanda A, Sharma M, Sonig A, et al. Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon's experience of 1576 patients. World Neurosurg 2014; 82:1380–1387.
Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007; 32:2310–2317.
Frempong-Boadu A, Houten JK, Osborn B, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 2002; 15:362–368.
Baron EM, Soliman AMS, Gaughan JP, et al. Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion. Ann Otol Rhinol Laryngol 2003; 112:921–926.
Danto J, Dicapua J, Nardi D, et al. Multiple cervical levels. J Neurosurg Anesthesiol 2012; 24:350–355.
Singh K, Marquez-Lara A, Nandyala SV, et al. Incidence and risk factors for dysphagia after anterior cervical fusion. Spine (Phila Pa 1976) 2013; 38:1820–1825.
Veeravagu A, Cole T, Jiang B, et al. Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine 2014; 14:1125–1131.
Riley LH, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 2005; 30:2564–2569.
Edwards CC, Karpitskaya Y, Cha C, et al. Accurate identification of adverse outcomes after cervical spine surgery. J Bone Joint Surg Am 2004; 86:251–256.
Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery. Neurosurgery 2010; 67:10–15.
Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery. Spine (Phila Pa 1976) 2002; 27:2453–2458.
Lee MJ, Bazaz R, Furey CG, et al. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J 2007; 7:141–147.
Erwood MS, Walters BC, Connolly TM, et al. Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach. J Neurosurg Spine 2018; 28:140–148.
Winslow CP, Winslow TJ, Wax MK. Dysphonia and dysphagia following the anterior approach to the cervical spine. Arch Otolaryngol Head Neck Surg 2001; 127:51–55.
Cho SK, Riew KD. Adjacent segment disease following cervical spine surgery. J Am Acad Orthop Surg 2012; 21:3–11.
van Eck CF, Regan C, Donaldson WF, et al. The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients. Spine 2014; 39:2143–2147.
Basques BA, Ondeck NT, Geiger EJ, et al. Differences in short-term outcomes between primary and revision anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2017; 42:253–260.
Weisberg N, Spengler D, Netterville J. Stretch-induced nerve injury as a cause of paralysis secondary to the anterior cervical approach. Otolaryngol Head Neck Surg 1997; 116:317–326.
Kriskovich MD, Apfelbaum RI, Haller JR. Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury. Laryngoscope 2000; 110:1467–1473.
Oliver JD, Goncalves S, Kerezoudis P, et al. Comparison of outcomes for anterior cervical discectomy and fusion with and without anterior plate fixation. Spine (Phila Pa 1976) 2018; 43:E413–E422.
Mehra S, Heineman TE, Cammisa FP, et al. Factors predictive of voice and swallowing outcomes after anterior approaches to the cervical spine. Otolaryngol Head Neck Surg 2013; 150:259–265.
Lo C-Y, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000; 135:204–207.
Rosenthal LHS, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007; 117:1864–1870.
Gowd A, Nazemi A, Carmouche J, et al. Indications for direct laryngoscopic examination of vocal cord function prior to anterior cervical surgery. Geriatr Orthop Surg Rehabil 2016; 8:54–63.