Tag: anterior cervical fusion

Posted on

Incidence and Risk Factors for Dysphagia After Anterior Cervical Fusion

ACDF

Spine 2013;38:1820–1825

Study Design. Retrospective database analysis.

Objective. To determine the national incidence, mortality, and risk factors for dysphagia associated with anterior cervical spinal fusion surgery in the United States.

Summary of Background Data. Dysphagia is a known complication associated with anterior cervical fusion (ACF). A population-based database was analyzed to characterize the incidence of dysphagia in terms of demographics, mortality, and risk factors associated with ACF.

Methods. Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project were obtained from 2002 to 2009. Patients undergoing ACF for cervical myelopathy and/ or radiculopathy were identifi ed and separated into cohorts (1- to 2-level and 3 + -level fusions), and incidences of dysphagia were identifi ed. Demographics, length of stay, costs, mortality, and use of bone morphogenetic proteins (BMPs) were assessed. Statistical data were analyzed in SPSS (version 20), using the Student t test for discrete variables and the χ 2 test for categorical data. Binomial logistic regression was used to identify independent predictors of dysphagia. A P value of less than 0.001 was used to denote signifi cance.

Results. A total of 159,590 ACF cases were identified of which 139,434 were 1- to 2-level ACF and 20,156 were 3 + -level ACF. The incidence of dysphagia in the 3 + -level ACF group was double that of the 1- to 2-level ACF group (44.8 vs . 22.4 per 1000; P < 0.001). Patients with dysphagia were significantly older than patients without dysphagia ( P < 0.001). Dysphagia was more common in males undergoing 1- to 2-level ACF ( P < 0.001). BMP was used more frequently for patients with dysphagia in the 1- to 2-level ACF group (9.4% vs . 7.2% of cases; P < 0.001). Logistic regression analysis demonstrated that independent predictors for dysphagia included age ( ≥ 65 yr), male sex, 3 + -level fusion, BMP use, and preoperative patient comorbidities.

Conclusion. Dysphagia occurs twice as often after 3 + -level ACF compared with 1- to 2-level ACF. Utilization of BMP was also linked to an increased incidence of dysphagia in the 1- to 2-level ACF group. Regardless of the number of levels fused, patients experiencing dysphagia had increased age, comorbid risk factors, hospitalizations, and costs.

Level of Evidence: 3

Posted on

The Efficacy of Plate Construct Augmentation Versus Cage Alone in Anterior Cervical Fusion

Spine 2009 Dec 15;34(26):2886-92.DOI: 10.1097/BRS.0b013e3181b64f2c

Study Design. Retrospective study.
Objective. To compare the efficacy of anterior cervical discectomy and fusion with cage alone (ACDF-CA) with cage and plate construct (ACDF-CPC) in regards to fusion rate, radiologic and clinical outcomes.
Summary of Background Data. ACDF-CA has shown good results; however, debate exists regarding the high rate of complications such as pseudarthrosis, subsidence, and local kyphosis. In an attempt to avoid these complications, the authors have performed ACDF with cage and plate construct (ACDF-CPC).
Methods. A total of 78 consecutive patients who underwent 1- or 2-level ACDF-CA or ACDF-CPC suffering from cervical radiculopathy were divided into 2 groups; Group A (n = 38) underwent ACDF-CA; Group B (n = 40) underwent ACDF-CPC. Fusion rate, segmental kyphosis, disc height, and subsidence rate were assessed by radiographs. Clinical outcomes were assessed using Robinson criteria.
Results. Solid fusion was achieved in 78.9% (30/38) of subjects in group A compared to 97.5% (39/40) of subjects in group B (P = 0.01). Segmental kyphosis was noted in 42.1% (16/38) in group A compared with 10% (4/40) in group B (P < 0.01). There was a significant decrease in disc height in group A compared to group B (P < 0.05). Subsidence occurred in 32.3% (19/59 levels) of group A compared with 9.7% (6/62 levels) of group B (P < 0.01). Clinical outcomes were similar for both treatment groups. The pseudarthrosis rate in group A was higher than that in group B (P = 0.01). Revision surgery was required in 10.5% (4/38) of group A, whereas none of group B required reoperation (P < 0.01).
Conclusion. The use of cage and plate construct in 1- or 2-level ACDF results in a more lordotic alignment, an increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rate than that of cage alone; however, there is no significant difference in clinical outcome between groups

Proudly powered by WordPress