Tag: Anterior cervical surgery

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Complications associated with anterior cervical spine surgery: A systematic review of literature

Brain and Spine 6 (2026) 105897

This systematic review examines complications following anterior cervical spine surgery, quantifying incidence rates across studies and identifying major risks such as dysphagia, adjacent segment disease, recurrent laryngeal nerve palsy, infection, pseudarthrosis, esophageal perforation, hematoma, and vertebral artery injury. It synthesizes data from 116 studies (1989–2024) and assesses study quality using the Newcastle–Ottawa Scale.

The review highlights key risk factors—multilevel procedures, revision surgery, OPLL, smoking, older age, and surgeon experience—and emphasizes the importance of preoperative planning, patient selection, standardized prospective monitoring, and timely management to minimize morbidity and guide informed consent and long-term surveillance.

Aim Quantify frequency, causes, and outcomes of complications associated with anterior cervical spine surgery.

Methods Systematic review following PRISMA; searched CINAHL Plus, MEDLINE, PubMed, Scopus, and EMBASE for English-language studies (1989–2024) in adults; quality assessed with the Newcastle Ottawa Scale.

Evidence base 326 records screened; 116 studies included; study quality ranged from 3/9 to 9/9 on NOS, with frequent weaknesses in external control selection and cohort comparability.

Most common complication (dysphagia) Reported incidence varied widely (2.3%–87.5%); overall rate across all included dysphagia studies was 13%, with higher pooled incidence in prospective vs retrospective cohorts (53.7% vs 12.7%).

Other key complications (ranges) Adjacent segment disease 0.4%–32%; recurrent laryngeal nerve palsy 0.1%–9%; infection 0.39%–8.5%; pseudarthrosis 0.25%–31%; esophageal perforation 0.1%–0.45%; vertebral artery injury 0.3%–7.7%; Horner’s syndrome 0.06%–0.45%; graft failure 2.7%–35.5%; CSF leak 0%–1%; postoperative hematoma 0.21%–7%; new/worsening neurological deficits 0.37%–3.3.

Risk factors (higher complication rates) Multilevel disease, revision surgery, and ossification of the posterior longitudinal ligament (OPLL) were associated with increased complications.

Volume–outcome effect Greater surgeon experience and higher case volume were consistently associated with lower complication rates.

Prevention emphasis Reducing complications depends on thorough preoperative planning, careful patient selection, and proper surgical technique.

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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 37:21–30, 2022

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, I 2 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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Results of a Prospective Randomized Study Comparing a Novel Retractor With a Caspar Retractor in Anterior Cervical Surgery

Neurosurgery 69[ONS Suppl 2]:ons156–ons160, 2011 DOI: 10.1227/NEU.0b013e318219565f

Retraction injury might explain the soft tissue complications seen after anterior cervical surgery. A novel retractor system (Seex retractor system [SRS]) that uses a principle of bone fixation with rotation has been shown to reduce retraction pressure in a cadaveric model of anterior cervical decompression and fusion.

OBJECTIVE: To compare the conventional Cloward-style retractor (CRS) with the SRS in a prospective randomized clinical trial.

METHODS: After ethics and study registration (ACTRN 12608000430336), eligible patients were randomized to either the CRS or SRS before 1- or 2-level anterior cervical decompression and fusion. The pressure beneath the medial retractor blade was recorded with a thin pressure transducer strip. Postoperative sore throat, dysphagia, and dysphonia were assessed after 1, 7, and 28 days.

RESULTS: Twenty-six patients were randomized. There were no serious complications. Complication rates were low with a trend favoring SRS that was not statistically different. Average retraction pressure with SRS was 1.9 mm Hg and with CRS was 5.6 mm Hg (P , .001 on F test; P = .002 on 2-tailed t test). Mean average peak retraction pressure with the SRS was 3.4 mm Hg and with the CRS was 20 mmHg (P , .001 on F test; P = .005 on 2-tailed t test).

CONCLUSION: The new retractor is safe, and statistically similar complication rates were observed with the 2 systems. The SRS generated significantly less retraction pressure compared with the CRS. This difference can be explained by the different principles governing the function of these retractors. Bone fixation gives stability and rotation reduces tissue pressure, both desirable in a retractor.

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