Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery

Gabriel A. Smith, Jonathan Pace, Mark Corriveau, Sungho Lee, Thomas E. Mroz, Ahmad Nassr, Michael G. Fehlings, Robert A. Hart, Alan S. Hilibrand, Paul M. Arnold, David B. Bumpass, Ziya Gokaslan, Mohamad Bydon, Jeremy L. Fogelson, Eric M. Massicotte, K. Daniel Riew, Michael P. Steinmetz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Study Design: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. Objective: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. Results: Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation. Conclusions: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation.

Original languageEnglish (US)
Pages (from-to)40S-45S
JournalGlobal Spine Journal
Volume7
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Spine
Incidence
Diskectomy
Reoperation
Length of Stay
North America
Decompression
Medical Records
Morbidity
Research
Surgeons
Therapeutics

Keywords

  • ACCF
  • ACDF
  • anterior cervical spine
  • corpectomy
  • diskectomy
  • implant extrusion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Smith, G. A., Pace, J., Corriveau, M., Lee, S., Mroz, T. E., Nassr, A., ... Steinmetz, M. P. (2017). Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery. Global Spine Journal, 7(1_suppl), 40S-45S. https://doi.org/10.1177/2192568216686752

Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery. / Smith, Gabriel A.; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Mroz, Thomas E.; Nassr, Ahmad; Fehlings, Michael G.; Hart, Robert A.; Hilibrand, Alan S.; Arnold, Paul M.; Bumpass, David B.; Gokaslan, Ziya; Bydon, Mohamad; Fogelson, Jeremy L.; Massicotte, Eric M.; Riew, K. Daniel; Steinmetz, Michael P.

In: Global Spine Journal, Vol. 7, No. 1_suppl, 01.04.2017, p. 40S-45S.

Research output: Contribution to journalArticle

Smith, GA, Pace, J, Corriveau, M, Lee, S, Mroz, TE, Nassr, A, Fehlings, MG, Hart, RA, Hilibrand, AS, Arnold, PM, Bumpass, DB, Gokaslan, Z, Bydon, M, Fogelson, JL, Massicotte, EM, Riew, KD & Steinmetz, MP 2017, 'Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery', Global Spine Journal, vol. 7, no. 1_suppl, pp. 40S-45S. https://doi.org/10.1177/2192568216686752
Smith, Gabriel A. ; Pace, Jonathan ; Corriveau, Mark ; Lee, Sungho ; Mroz, Thomas E. ; Nassr, Ahmad ; Fehlings, Michael G. ; Hart, Robert A. ; Hilibrand, Alan S. ; Arnold, Paul M. ; Bumpass, David B. ; Gokaslan, Ziya ; Bydon, Mohamad ; Fogelson, Jeremy L. ; Massicotte, Eric M. ; Riew, K. Daniel ; Steinmetz, Michael P. / Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery. In: Global Spine Journal. 2017 ; Vol. 7, No. 1_suppl. pp. 40S-45S.
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abstract = "Study Design: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. Objective: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9{\%} to 20{\%} and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. Results: Following anterior cervical fusion, the incidence of IE ranged from 0.0{\%} to 0.8{\%} across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64{\%}) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64{\%}) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18{\%}) had residual deficits after reoperation. Conclusions: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation.",
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AU - Nassr, Ahmad

AU - Fehlings, Michael G.

AU - Hart, Robert A.

AU - Hilibrand, Alan S.

AU - Arnold, Paul M.

AU - Bumpass, David B.

AU - Gokaslan, Ziya

AU - Bydon, Mohamad

AU - Fogelson, Jeremy L.

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N2 - Study Design: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. Objective: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. Results: Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation. Conclusions: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation.

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