Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion

View More View Less
  • Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia. The overall risks of these complications and rates of dysphagia are not well studied for surgery on 4 or more segments. In this study, the authors evaluated their institution’s perioperative experience with 4- and 5-level ACDFs.

METHODS

The authors retrospectively reviewed patients who underwent 4- or 5-level ACDF at their institution over a 6-year period (May 2013–May 2019). Patient demographics, perioperative complications, readmission rates, and swallowing outcomes were recorded. Outcomes were analyzed with a multivariate linear regression.

RESULTS

A total of 174 patients were included (167 had 4-level and 7 had 5-level ACDFs). The average age was 60.6 years, and 54.0% of patients (n = 94) were men. A corpectomy was performed in 12.6% of patients (n = 22). After surgery, 56.9% of patients (n = 99) experienced dysphagia. The percentage of patients with dysphagia decreased to 22.8% (37/162) at 30 days, 12.9% (17/132) at 90 days, and 6.3% (5/79) and 2.8% (1/36) at 1 and 2 years, respectively. Dysphagia was more likely at 90 days postoperatively in patients with gastroesophageal reflux (OR 4.4 [95% CI 1.5–12.8], p = 0.008), and the mean (± SD) lordosis change was greater in patients with dysphagia than those without at 90 days (19.8° ± 13.3° vs 9.1° ± 10.2°, p = 0.003). Dysphagia occurrence did not differ with operative implants, including graft and interbody type. The mean length of time to solid food intake was 2.4 ± 2.1 days. Patients treated with dexamethasone were more likely to achieve solid food intake prior to discharge (OR 4.0 [95% CI 1.5–10.6], p = 0.004). Postsurgery, 5.2% of patients (n = 9) required a feeding tube due to severe approach-related dysphagia. Other perioperative complication rates were uniformly low. Overall, 8.6% of patients (n = 15) returned to the emergency department within 30 days and 2.9% (n = 5) required readmission, whereas 1.1% (n = 2) required unplanned return to surgery within 30 days.

CONCLUSIONS

This is the largest series of patients undergoing 4- and 5-level ACDFs reported to date. This procedure was performed safely with minimal intraoperative complications. More than half of the patients experienced in-hospital dysphagia, which increased their overall length of stay, but dysphagia decreased over time.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; EBL = estimated blood loss; ED = emergency department; GERD = gastroesophageal reflux disease; LOS = length of stay; PEEK = polyetheretherketone; PEG = percutaneous endoscopic gastrostomy.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence U. Kumar Kakarla: c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ. neuropub@barrowneuro.org.

INCLUDE WHEN CITING Published online April 2, 2021; DOI: 10.3171/2020.10.SPINE201307.

Disclosures Dr. Uribe: consultant for NuVasive Medical, Masonix, and SI Bone; and royalties from NuVasive Medical. Dr. Turner: consultant for and royalties from NuVasive Medical. Dr. Chang: consultant for Globus Medical and royalties from Globus Medical and Zimmer Biomet.

  • 1

    Oliver JD, Goncalves S, Kerezoudis P, et al. . Comparison of outcomes for anterior cervical discectomy and fusion with and without anterior plate fixation: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2018;43(7):E413E422.

    • Search Google Scholar
    • Export Citation
  • 2

    Wang SJ, Ma B, Huang YF, et al. . Four-level anterior cervical discectomy and fusion for cervical spondylotic myelopathy. J Orthop Surg (Hong Kong). 2016;24(3):338343.

    • Search Google Scholar
    • Export Citation
  • 3

    Chang SW, Kakarla UK, Maughan PH, et al. . Four-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Neurosurgery. 2010;66(4):639647.

    • Search Google Scholar
    • Export Citation
  • 4

    Kreitz TM, Hollern DA, Padegimas EM, et al. . Clinical outcomes after four-level anterior cervical discectomy and fusion. Global Spine J. 2018;8(8):776783.

    • Search Google Scholar
    • Export Citation
  • 5

    Kim S, Alan N, Sansosti A, et al. . Complications after 3- and 4-level anterior cervical diskectomy and fusion. World Neurosurg. 2019;130:e1105e1110.

    • Search Google Scholar
    • Export Citation
  • 6

    Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):24532458.

    • Search Google Scholar
    • Export Citation
  • 7

    Vaishnav AS, Saville P, McAnany S, et al. . Predictive factors of postoperative dysphagia in single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2019;44(7):E400E407.

    • Search Google Scholar
    • Export Citation
  • 8

    Jeyamohan SB, Kenning TJ, Petronis KA, et al. . Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial. J Neurosurg Spine. 2015;23(2):137143.

    • Search Google Scholar
    • Export Citation
  • 9

    Smith-Hammond CA, New KC, Pietrobon R, et al. . Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29(13):14411446.

    • Search Google Scholar
    • Export Citation
  • 10

    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(5):362368.

    • Search Google Scholar
    • Export Citation
  • 11

    Min Y, Kim WS, Kang SS, et al. . Incidence of dysphagia and serial videofluoroscopic swallow study findings after anterior cervical discectomy and fusion: a prospective study. Clin Spine Surg. 2016;29(4):E177E181.

    • Search Google Scholar
    • Export Citation
  • 12

    Riley LH III, Skolasky RL, Albert TJ, et al. . Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976). 2005;30(22):25642569.

    • Search Google Scholar
    • Export Citation
  • 13

    Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. . Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007;32(21):23102317.

    • Search Google Scholar
    • Export Citation
  • 14

    Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J. 2005;14(7):677682.

    • Search Google Scholar
    • Export Citation
  • 15

    Opsenak R, Kolarovszki B, Benco M, et al. . Dysphagia after anterior cervical discectomy and interbody fusion - prospective study with 1-year follow-up. Rozhl Chir. 2019;98(3):115120.

    • Search Google Scholar
    • Export Citation
  • 16

    Veeravagu A, Cole T, Jiang B, Ratliff JK. Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine J. 2014;14(7):11251131.

    • Search Google Scholar
    • Export Citation
  • 17

    Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602617.

  • 18

    Cloward RB. New method of diagnosis and treatment of cervical disc disease. Clin Neurosurg. 1962;8:93132.

  • 19

    Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for the cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223224.

    • Search Google Scholar
    • Export Citation
  • 20

    Wang B, G, Kuang L. Anterior cervical discectomy and fusion with stand-alone anchored cages versus posterior laminectomy and fusion for four-level cervical spondylotic myelopathy: a retrospective study with 2-year follow-up. BMC Musculoskelet Disord. 2018;19(1):216.

    • Search Google Scholar
    • Export Citation
  • 21

    De la Garza-Ramos R, Xu R, Ramhmdani S, et al. . Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2016;24(6):885891.

    • Search Google Scholar
    • Export Citation
  • 22

    Yu S, Li F, Yan N, et al. . Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused. PLoS One. 2014;9(3):e91329.

    • Search Google Scholar
    • Export Citation
  • 23

    Kalb S, Reis MT, Cowperthwaite MC, et al. . Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg. 2012;77(1):183187.

    • Search Google Scholar
    • Export Citation
  • 24

    Iyer S, Kim HJ, Bao H, et al. . Cervical deformity patients have baseline swallowing dysfunction but surgery does not increase dysphagia at 3 months: results from a prospective cohort study. Global Spine J. 2019;9(5):532539.

    • Search Google Scholar
    • Export Citation
  • 25

    Radcliff KE, Bennett J, Stewart RJ, et al. . Change in angular alignment is associated with early dysphagia after anterior cervical discectomy and fusion. Clin Spine Surg. 2016;29(6):248254.

    • Search Google Scholar
    • Export Citation
  • 26

    Yew AY, Nguyen MT, Hsu WK, Patel AA. 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(2):E82E88.

    • Search Google Scholar
    • Export Citation
  • 27

    Siasios I, Fountas K, Dimopoulos V, Pollina J. The role of steroid administration in the management of dysphagia in anterior cervical procedures. Neurosurg Rev. 2018;41(1):4753.

    • Search Google Scholar
    • Export Citation
  • 28

    Jenkins TJ, Nair R, Bhatt S, et al. . The effect of local versus intravenous corticosteroids on the likelihood of dysphagia and dysphonia following anterior cervical discectomy and fusion: a single-blinded, prospective, randomized controlled trial. J Bone Joint Surg Am. 2018;100(17):14611472.

    • Search Google Scholar
    • Export Citation
  • 29

    Laratta JL, Reddy HP, Bratcher KR, et al. . Outcomes and revision rates following multilevel anterior cervical discectomy and fusion. J Spine Surg. 2018;4(3):496500.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 268 268 268
Full Text Views 96 96 96
PDF Downloads 149 149 149
EPUB Downloads 0 0 0