Adverse Events Associated With Anterior Cervical Spine Surgery

J Am Acad Orthop Surg, Vol 16, No 12, December 2008 Alan H. Daniels, MD, K. Daniel Riew, MD, J. U. Yoo, MD, Alexander Ching, MD, Keith R. Birchard, MD, Andy J. Kranenburg, MD and Robert A. Hart, MD

Anterior cervical procedures for neurologic decompression and fusion, including cervical diskectomy and cervical corpectomy, are commonly performed by orthopaedic surgeons and spinal neurosurgeons. These procedures are highly successful in treating most patients with persistent pain and neurologic symptoms that have not responded to nonsurgical methods. Adverse events occur infrequently, but several have been described, including esophageal injury, vertebral artery injury, dural tear, postoperative airway compromise, spinal cord injury, hematoma, dysphagia, dysphonia, and graft dislodgement. Newer procedures, such as cervical total disk replacement and the use of bone morphogenetic protein as a supplement to fusion, have raised unique concerns. Appropriate strategies must be utilized to avoid these adverse events, and the treating surgeon should have an understanding of how to detect and manage such events when they do arise.