Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery.

Authors

Gabriel A. Smith, University Hospitals Case Medical CenterFollow
Jonathan Pace, University Hospitals Case Medical Center
Mark Corriveau, University of Wisconsin Hospital and ClinicsFollow
Sungho Lee, University Hospitals Case Medical CenterFollow
Thomas E. Mroz, Cleveland Clinic
Ahmad Nassr, Mayo Clinic
Michael G. Fehlings, Toronto Western HospitalFollow
Robert A. Hart, Oregon Health and Science UniversityFollow
Alan S. Hilibrand, Thomas Jefferson UniversityFollow
Paul M. Arnold, Kansas University Medical CenterFollow
David B. Bumpass, University of Arkansas for Medical Sciences
Ziya Gokaslan, Brown University; Rhode Island Hospital; Miriam HospitalFollow
Mohamad Bydon, Mayo Clinic
Jeremy L. Fogelson, Mayo Clinic
Eric M. Massicotte, Toronto Western HospitalFollow
K. Daniel Riew, Columbia University; NewYork-Presbyterian/The Allen HospitalFollow
Michael P. Steinmetz, Cleveland Clinic FoundationFollow

Document Type

Article

Publication Date

4-1-2017

Comments

This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 1, April 2017, Pages 40S-45S.

The published version is available at DOI: 10.1177/2192568216686752. Copyright © Smith et al.

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.

Recommended Citation

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; and Steinmetz, Michael P., "Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery." (2017). Rothman Institute Faculty Papers. Paper 90.
https://jdc.jefferson.edu/rothman_institute/90

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