Comparison of prevertebral soft tissue swelling and dysphagia between Zero-p and traditional cage and titanium plate for anterior cervical discectomy with fusion / 局解手术学杂志

Objective To explore the relationship among the prevertebral soft tissue swelling and dysphagia rate after anterior cervical diskectomy and fusion(ACDF),and to investigate the prevertebral soft tissue swelling and dysphagia rate after Zero-p or traditionaI cage and titanium plate for one-level lesion of cervical myelopathy.Methods The clinical data of 54 patients with one-level lesion (C5/6) of cervical myelopathy who undelwent anterior cenrical discectomy and fusion by Zero-p (n =25) or traditional cage and titanium plate (n =29) were analyzed.The postoperative prevertebral soft tissue swelling was measured by lateral radiographs.Patients were divided into the swelling group (n =24) and the non-swelling group(n =30) based on the degree of prevertebral soft tissue swelling and the incidences of dysphagia were analyzed.Patients were divided into the Zero-p group (n =25)and the Cage group (n =29) based on surgical treatment,the postoperative prevertebral soft tissue swelling and dysphagia rate were compared.Results The rate of dysphagia in swelling group was 45.8％,which was higher than 13.3％ in non-swelling group,the difference was significant(P ＜0.05).The postoperative prevertebral soft tissue swelling was 6.22 mm averagely after Zreo-p,which was less than that after traditional cage and titanium plate for anterior cervical discectomy with fusion(9.25 mm),the difference was significant (P ＜ 0.05).The incidence of dysphagia in Zero-p group was 12％,which was lower than 41.4％ in Cage group,and the difference was statistically significant (P ＜ 0.05).Conclusion It is a clinical significance to evaluate the degree of prevertebral soft tissue swelling by cervical lateral X-ray after ACDF,when the degree of prevertebral soft tissue swelling is greater,the incidence of complications such as dysphagia is higher.In addition,The Zero-p for the treatment of single one-level lesion of cervical myelopathy(C5/6) has a lower degree of prevertebral soft tissue swelling and dysphagia rate than the traditional Cage and titanium plate fusion.

Clinical significance of X-ray lateral radiograph for evaluating the postoperative prevertebral soft tissue swelling after anterior cervical fusion / 局解手术学杂志

Objective To explore the relationship among the prevertebral soft tissue swelling, surgical extent, surgical segments, and complications and to investigate the clinical significance of lateral radiographs for evaluating the postoperative prevertebral soft tissue swelling. Methods 123 patients who underwent anterior cervical fusion with plate augmentation for cervical spondylosis were included in this study. The postoperative prevertebral soft tissue swelling was measured by lateral radiographs. The data were analysed according to surgical extent and surgical segments. Patients were divided into the swelling group (61cases, >9. 98 mm) and the non-swelling group (62 cases, <9. 98 mm) based on the degree of prevertebral soft tissue swelling. The incidences of complications, such as dyspnea and dysphagia, were ana-lysed. Results The rate of dyspnea was 21. 3% in swelling group, which was higher than 8. 1% in non-swelling group (P<0. 05). The rate of dysphagia was 83. 6% in swelling group, which was higher than 25. 8% in non-swelling group (P<0. 05). In addition, postoperative prevertebral soft tissue swelling was 8. 29 mm averagely after one-level fusion, which was less than that after two or more levels fusion (11. 55 mm and 10. 40 mm) (P<0. 05). Postoperative prevertebral soft tissue swelling was 10. 94 mm after high-level fusion (above C4), which was more than that low-level fusion (below C5) (8. 63 mm) (P<0. 05). Conclusion After anterior cervical fusion for cervical spondylosis, when the degree of prevertebral soft tissue swelling is greater the incidences of complications such as dyspnea and dysphagia might be higher. In addition, prevertebral soft tissue swelling increments are significantly greater in patients who had undergone multi-level or high-level fusion ( above C5 ) . Evaluation of prevertebral soft tissue swelling using lateral radiographs is a clinically meaningful procedure.

Comparative Study of Clinical and Radiological Outcomes of a Zero-Profile Device Concerning Reduced Postoperative Dysphagia after Single Level Anterior Cervical Discectomy and Fusion

OBJECTIVE: This study analyzed clinical and radiological outcomes of a zero-profile anchored spacer (Zero-P) and conventional cage-plate (CCP) for single level anterior cervical discectomy and fusion (ACDF) to compare the incidence and difference of postoperative dysphagia with both devices. METHODS: We retrospectively reviewed our experiences of single level ACDF with the CCP and Zero-P. From January 2011 to December 2013, 48 patients who had single level herniated intervertebral disc were operated on using ACDF, with CCP in 27 patients and Zero-P in 21 patients. Patients who received more than double-level ACDF or combined circumferential fusion were excluded. Age, operation time, estimated blood loss (EBL), pre-operative modified Japanese Orthopaedic Association (mJOA) scores, post-operative mJOA scores, achieved mJOA scores and recovery rate of mJOA scores were assessed. Prevertebral soft tissue thickness and postoperative dysphagia were analyzed on the day of surgery, and 2 weeks and 6 months postoperatively. RESULTS: The Zero-P group showed same or favorable clinical and radiological outcomes compared with the CCP group. Postoperative dysphagia was significantly low in the Zero-P group. CONCLUSIONS: Application of Zero-P may achieve favorable outcomes and reduce postoperative dysphagia in single level ACDF.

Negative Pressure Pulmonary Edema Associated with Anterior Cervical Spine Surgery

We report a very rare case of negative pressure pulmonary edema (NPPE) that occurred immediately after anterior cervical discectomy and fusion (ACDF). The patient was a 25-year-old man who sustained a facet fracture-dislocation of C5 during a traffic accident. After ACDF, he developed NPPE and needed mechanical ventilation. Fortunately, he recovered fully within 24 hours. NPPE is a rare postoperative complication that may occur after cervical spine surgery. The aims of this report are to present information regarding the diagnosis and emergent treatment of NPPE, and to review the previous literature regarding this serious complication.

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion: Comparison between Plate Fixation and Cage Insertion / 대한정형외과학회잡지

PURPOSE: We wanted to identify the natural course of prevertebral soft tissue swelling after performing one-level or two-level anterior cervical discectomy and fusion (ACDF), and we compared the prevertebral soft tissue swelling between the plate and cage groups, and we wanted to help preventing potentially lethal airway complications after ACDF. MATERIALS AND METHODS: One hundred thirteen patients who underwent one-level or two-level ACDF with plate and screws or cages were studied. Eighty-seven patients underwent ACDF using plates and twenty-six underwent ACDF using cages. Cervical spine lateral radiography was taken preoperatively, on the immediate postoperative day and on the 1st, 2nd, 3rd, 4th and 5th days after surgery. The prevertebral soft tissue was measured from C2 to C6 on the cervical spine lateral radiography. RESULTS: Prevertebral soft tissue swelling occurred postoperatively and the peak level was found on the second and third days after surgery. The prevertebral soft tissue swelling was gradually decreased from the fourth day after surgery. Prominent swelling of the prevertebral soft tissue was found at the 2nd, 3rd and 4th cervical spines. There were no significant differences of the prevertebral soft tissue swelling between the one-level and two-level ACDF groups. The cage insertion group showed less swelling than did the plate fixation group. CONCLUSION: The peak prevertebral soft tissue swelling was found on the second and third days after surgery. The cage insertion group showed less swelling than did the plate fixation group.

Prevertebral Soft Tissue Swelling After Anterior Cervical Discectomy and Fusion / 대한척추외과학회지

STUDY DESIGN: Prospective study of 87 patients OBJECTIVES: To identify the natural course of the prevertebral soft tissue swelling after a one- or two-level anterior cervical discectomy and fusion (ACDF) and to help prevent potentially lethal airway complications after an ACDF. SUMMARY OF LITERATURE REVIEW: Airway complication after anterior cervical surgery is rare but potentially lethal. MATERIALS AND METHODS: Eighty-seven patients who underwent a one- or two-level ACDF with a plate and screws were examined. Cervical spine lateral radiography was taken preoperatively, on the immediate postoperative day, 1st, 2nd, 3rd, 4th and 5th day after surgery. Prevertebral soft tissue was measured from C2 to C6 on the cervical spine lateral radiography. RESULTS: Prevertebral soft tissue swelling occurred postoperatively and increased markedly on the second day after surgery. The peak prevertebral soft tissue swelling was observed on the second and third day after surgery. The prevertebral soft tissue swelling was decreased gradually from the 4th day after surgery. Prominent swelling of the prevertebral soft tissue was found at the 2nd, 3rd and 4th cervical spine. There were no significant differences in the prevertebral soft tissue swelling between the one-level and two-level ACDF group. Only one patient required reintubation (1.1%) CONCLUSIONS: The peak prevertebral soft tissue swelling was observed on the second and third day after surgery. Therefore, maintaining intubation for 3 or 4 days after surgery would be helpful in high-risk patients.