Complications and mistakes after anterior cervical interbody fusion with autologous bone grafts

Oleksandr Barysh, Eduard Fedoryna

Abstract


Full coalescence after the anterior interbody fusion using bone cortical-cancellous iliac crest autografts and rigid plates in the surgical treatment of fresh injuries of the cervical spine may be reached in 95–100 % of cases. Despite on this the number of unsatisfactory results of operations related to bone graft amounts 50.7 %, and complications due to the use of hardware can range from 5 % to 35 %. Objective: To analyze the complications and mistakes after the anterior interbody bone fusion using cortical-cancellous iliac crest autografts and rigid plates in cases of surgical treatment of the subaxialcervical functional spinal units’ injuries. Material and Methods: There were analyzed outcomes in 123 patients with fresh cervical spine injuries, 91 (73.9 %) men and 32 (26.08 %) of women aged from 16 to 67 years among them. For all patients we performed decompressive and stabilizing surgeries by means of bone cortical-cancellous autografts from the ipsilateral iliac crest and rigid plates developed at the Institute according to known and designed at the Institute techniques. Time from injury to surgery ranged from 3 to 42 hours (mean, 9.54 hours), and duration of surgery ranged from 90 to 210 minutes (average, 1 hour 50 minutes). All patients were examined clinically and radiologically by known methods. Results: An interbody fusion was achieved in 95.8 % of cases, and the overall complication rate was 30.9 %. All complications and mistakes were systematized and analyzed. The greatest number of complications was associated with metal constructs (11.38 %), with bone graft implemented in interbody space (4.87 %) and occurred on the site of the donor wound (5.69 %). The least amount of complications was observed at the postoperative cervical wound region (3.24 %). Conclusions: Enhancement of a technique for the anterior interbody fusion by means of bone autografts and cervical rigid plates and careful compliance with the principles of stabilization of the cervical functional spinal units as well as rules for such surgeries will prevent technical mistakes, reduce the number of complications and improve outcome.


Keywords


cervical spine; anterior cervical interbody fusion; bone cortical-cancellousautograft; rigid plates; complications

References


Adverse events associated with anterior cervical spine surgery / A. H. Daniels, K. D. Riew, J. U. Yoo [et al.] // J. Am. Acad. Orthop. Surg. — 2008. — Vol. 16 (12). — P. 729–738.

Anterior cervical locking plate-related complications; prevention and treatment recommendations / X. Ning, Y. Wen, Y. Xiao-Jian [et al.] // International Orthopaedics. — 2008. — Vol. 32 (5). — P. 649–655.

Clark C. R. The cervical spine / C. R. Clark. — 4th ed. — Philadelphia-Tokyo: Lippincott Williams & Wilkins, 2005. — 1250 p.

Complications in spine surgery / R. Nasser, S. Yadla, M. G. Maltenfort [et al.] // J. Neurosurg. Spine. — 2010. — Vol. 13 (2). — P. 144–157, doi: 10.3171/2010.3.SPINE0936.

Complications of multilevel anterior cervical fusion / Y.-H. Pan, C.-Y. Cheng, J.-F. Lin [et al.] // Tzu Chi Med J. — 2004. — Vol. 16 (2). — P. 79–84.

Daffner S. D. Anterior cervical fusion: the role of anterior plating / S. D. Daffner, J. C. Wang // Instr. Course Lect. — 2009. — Vol. 58. — P. 689–698.

Donor site morbidity after anterior iliac crest bone harvest for single-level anterior discectomy and fusion / J. S. Silber, D. G. Anderson, S. D. Daffner [et al.] // Spine. — 2003. — Vol. 28 (2). — P. 134–139.

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques / R. Pollock, I. Alcelik, C. Bhatia [et al.] // Eur. Spine J. — 2008. — Vol. 17 (6). — P. 845–852, doi: 10.1007/s00586-008-0648-3.

Epstein N. E. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery / N. E. Epstein // Surg. Neurol. Int. — 2012. — Vol. 3, Suppl. 3. — P. S143–S156, doi: 10.4103/2152-7806.98575.

Oesophageal perforation after anterior cervical surgery: management in four patients / H. Ardon, F. Van Calenberg, D. Van Raemdonck [et al.] // Acta Neurochir. — 2009. — Vol. 151 (4). — P. 297–302, doi: 10.1007/s00701-009-0241-5.

Quale A. Infections associated with spinal implants / A. Quaile // International Orthopaedics. — 2012. — Vol. 36 (2). — P. 451–456, doi: 10.1007/s00264-011-1408-2.

Seiler J. G. Iliac crest autogenous bone grafting: donor site complications / J. G. Seiler, J. Johnson // J. South Orthop. Assoc. — 2000. — Vol. 9 (2). — P. 91–97.

Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical plating / D. Solerio, E. Ruffini, G. Gargiulo [et al.] // Eur. Spine J. — 2008. — Vol. 17, Suppl. 2. — P. S280–S284.

Yue W.-M. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study / W.-M. Yue, W. Brodner, T. R. Highland // Eur. Spine J. — 2005. — Vol. 14. — P. 677–682.

Zeidman S. M. Trends and complications in cervical spine surgery: 1989–1993 / S. M. Zeidman, T. B. Ducker, J. Raycroft // J. Spinal Disord. — 1997. — Vol. 10. — P. 523–526.




DOI: https://doi.org/10.15674/0030-59872014497-103

Refbacks

  • There are currently no refbacks.


Copyright (c) 2014 Oleksandr Barysh, E. Fedoryna

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.