P18. Postoperative complications in anterior cervical surgery: is there a higher incidence of dysphagia and respiratory complications with long-segment anterior cervical surgery?

Background Context

In anterior cervical spine surgery, complications such as dysphagia and respiratory disorders can be problematic.

Purpose

This study investigates whether the length of fixation in anterior cervical spine surgery is associated with perioperative dysphagia and respiratory complications.

Study Design/Setting

Retrospective study.

Patient Sample

N/A

Outcome Measures

N/A

Methods

The subjects were 105 cases who underwent anterior cervical spine surgery at our hospital since April 2013. Cases involving surgery for trauma or infection were excluded. Cases with fixation of two or fewer vertebrae were classified as Group S, and those with fixation of three or more vertebrae as Group L. In our hospital, when anterior fixation of 3 or more vertebrae is performed, airway management is generally conducted in the ICU by emergency physicians, with the timing of extubation determined based on the cuff leak test, lateral cervical spine X-rays, and fiberscope if necessary.

The parameters examined were the frequency of dysphagia, the frequency of serious respiratory complications such as reintubation or tracheostomy, and pneumonia, as well as the number of days required for discharge or transfer postoperatively.

Results

There were 61 cases in Group S and 44 in Group L. The average number of fixed vertebrae was 1.5 in Group S and 3.5 in Group L. There was no significant difference in average age or sex between the two groups. Surgeries for ossification of the posterior longitudinal ligament were significantly more frequent in Group L. The proportion of severe dysphagia requiring gastrostomy tube for nutritional management was significantly higher in Group L (Group S; 3%, Group L; 13%). The number of cases requiring treatment for severe pneumonia, reintubation, or tracheostomy was one in Group S and four in Group L. One case in Group S developed severe pneumonia early postoperatively and required reintubation, and three cases in Group L required airway resecuring due to laryngeal edema post-extubation. The number of days required for discharge or transfer postoperatively was 11.9 days in Group S and 24.7 days in Group L, but cases with respiratory complications required an average of 58.8 days of hospital management.

Conclusions

Cases with short-segment anterior cervical surgeries had relatively few complications and could be discharged early. Long-segment anterior cervical spine surgeries are associated with higher rates of postoperative complications, including severe dysphagia in 13% of cases and significant respiratory issues in 9%. Cases with these complications required long-term hospitalization. These findings emphasize the necessity of careful monitoring and management following long-range anterior surgeries.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.