Slovenská chirurgia 1/2021

Infectious complications in anterior cervical disectomies

Introduction: Anterior cervical spine surgery is associated with satisfactory results and a relatively low percentage of complications. The most common type of surgical procedure is an anterior cervical discectomy and fusion with an intervertebral disc replacement, and in cases of two or three intervertebral disc replacements, anterior cervical plate is used. Complications of anterior cervical spine surgery are rare, with no apparent preoperative risk factor. Their early recognition, correct and adequate management are most important for the postoperative outcome of the patient and the quality of his life. Material and Methods: From 1.1.2015 to 31.12.2019, an anterior cervical discectomy was performed at the Department of Neurosurgery at the Medical Faculty of Safarik University and University Hospital in Košice in 789 patients. Infectious complications were evaluated retrospectively. The management of the infectious complication and the result, as well as possible risk factors, were recorded. Results: Between 789 patients with anterior cervical spine surgery, single-level cervical discectomy was performed in 476 patients, two level cervical disc replacement in 283 patients, and a three-level discectomy was performed in 30 patients. Interbody cages were used 840 times, spinal cages with screws 168 times, and cages with anterior plate fixation were used 33 times. Semi-dynamic replacement was performed 78 times and cervical disc arthroplasty in 13 patients. All cages were PEEK interbody fusion cages, or PEEK with titanium coating, semi-dynamic were titanium and cervical disc arthroplasty prosthesis was titanium with nucleus from viscoelastic polymer and artificial annulus from ultrahigh molecular weight polyethylene. Infectious complications occurred in 6 patients, representing an extremely low percentage of the complication, 0.76%. The patients’ mean age was 50,16 years, with 382 men and 407 women in the cohort. The average duration of the operation was 86,43 min. There was www.solen.sk | 2021;18(1) | Slovenská chirurgia Pôvodné práce 11 a statistically significantly longer time of surgery in patients with a postoperative infectious complication, p<0,001. In the cases of 6 patients with an infectious complication, four patients had multi-level cervical discectomy; in 2 patients, the operation was single-level cervical discectomy. Multi-level cervical discectomy significantly increases the risk of infectious complication, p<0,001. Treatment in 5 patients with postoperative infection was conservative with intravenous antibiotics. In one patient with extensive infection and prevertebral abscess, surgical treatment was required, surgical revision and evacuation of the abscess were performed, followed by extraction of the prosthesis with corpectomy and anterior fixation. In all patients, treatment for the infectious complication after the anterior cervical spine surgery was successful. No mortality was recorded in the study group. Conclusion: For the patient with cervical disc herniation, anterior cervical discectomy and fusion has excellent and satisfactory results with a relatively low percentage of complications. The incidence of postoperative infection after anterior cervical discectomy is extremely low. Despite the low percentage of infectious complications, early diagnosis and proper, rapid, and adequate treatment are important for the patient’s postoperative outcome and quality of life.

Keywords: anterior cervical discectomy and fusion, cervical disc arthroplasty, spine surgery, intervertebral disc replacement, infectious complications