• Journal of Trauma and Injury
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• 제25권4호
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• pp.278-282
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• 2012

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.450-454
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• 2006

The incidence of vertebral artery injury during the anterior approach to the cervical spine is rare, but potentially lethal. The authors describe two cases of vertebral artery injury during anterior cervical decompression surgery. In the first case, infection was the cause of the vertebral artery injury. During aggressive irrigation and pus drainage, massive bleeding was encountered, and intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm. In the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. After intraoperative control of bleeding, the patient was referred to our hospital, and a pseudoaneurysm was detected by angiography four days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurological sequelae. Urgent vertebral angiography, following intraoperative control of bleeding by hemostatic compression in cases of vertebral artery injury during anterior cervical decompression, should be performed to avoid life-threatening complications. Prompt recognition of pseudoaneurysm is mandatory, and endovascular treatment can be life saving.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.419-422
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• 2006

Objective : Endotracheal tube cuff-pressure[ETCP] increases significantly during anterior cervical spine surgery with neck retraction. Clinically, postoperative hoarseness with sore throat is correlated with vocal cord edema due to longer intubation time and higher ETCP during neck retraction. Methods : Fifty patients of anterior cervical spine surgery were randomized to a control [no adjustment, 25 cases] and a treatment group [ETCP adjusted to 20mmHg, 25 cases]. Patients were blinded to their group assignments. They were questioned about the presence of ischemic symptoms [sore throat, dysphagia, hoarseness] postoperatively at different time points; 4 hours, 24 hours, and 1 week postoperatively. Results : No differences between groups at 4 hours and 1 week postoperatively were demonstrated. At 24 hours, 36% of patients in the treatment group complained of sore throat while 56% of control group patients did [p < 0.05]. Female patients correlated with development of all ischemic discomfort [p < 0.05 : sore throat, hoarseness, dysphagia]. Conclusion : Our results suggest that postoperative ischemic symptom following anterior cervical spine surgery may be associated with the two predictors; increased ETCP during neck retraction and female. The simple procedure of maintaining ETCP to 20mmHg can prevent postoperative tracheal ischemic symptom.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.36-41
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• 2015

Objective : To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. Methods : Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. Results : With a mean follow-up of $29.7{\pm}12.1$ months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p< 0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. Conclusion : Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.422-426
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• 2005

Objective: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. Methods: 41 patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. Results: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were $4.2{\pm}1.8mm,\;23.5{\pm}7.2^{\circ},\;2.3{\pm}3.3^{\circ}$ pre-operatively and $5.3{\pm}2.1mm,\;24.2{\pm}8.3^{\circ},\;3.8{\pm}3.5^{\circ}$ at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. Conclusion: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.541-543
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• 2010

The purpose of this case report is to describe a rare case of a cervicothoracic spinal epidural hematoma (SEH) after anterior cervical spine surgery. A 60-year-old man complained of severe neck and arm pain 4 hours after anterior cervical discectomy and fusion at the C5-6 level. Magnetic resonance imaging revealed a postoperative SEH extending from C1 to T4. Direct hemostasis and drainage of loculated hematoma at the C5-6 level completely improved the patient's condition. When a patient complains of severe neck and/or arm pain after anterior cervical spinal surgery, though rare, the possibility of a postoperative SEH extending to non-decompressed, adjacent levels should be considered as with our case.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.231-238
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• 2001

Vertebral artery injury is a rare complication of anterior cervical approach. We report two patients who suffered injury to vertebral artery during anterior cervical spine surgery. The mechanism of injury, their operative management, and the subsequent outcome were assessed and relevant literatures reviewed. The awareness of the possibility of vertebral artery injury is most important to prevent and it's occurrence is best avoided by a thorough understanding of the anatomical relationships of the artery, the spinal canal, and the vertebral body and careful use of surgical instruments.

• 대한정형외과학회지
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• 제56권6호
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• pp.519-524
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• 2021

척추 수술 후 뇌수막염은 매우 드물게 발생하지만 치명적일 수 있다. 49세 남자 환자가 제5, 6 경추부의 추간판 탈출증에 의한 압박성 척수증 진단하에 전방 경추부 감압술 및 유합술을 시행받았다. 술 후 심한 경부통 및 경부 강직, 발열이 발생하였고 수술 일주일 째 갑자기 사지 마비 증상을 보였다. 추시 자기공명영상 검사 및 뇌척수액 검사상 세균성 뇌수막염과 동반된 척수염이 확인되었다. 환자는 항생제 및 스테로이드 치료를 시행받았으나 결과는 불량하였다. 저자들은 전방 경추 수술 이후 발생한 뇌수막염과 동반된 척수염 증례에 대하여 문헌 고찰과 함께 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.300-305
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• 2012

Objective : The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. Methods : Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. Results : The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was $32.2-42.4^{\circ}$. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. Conclusion : These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.83-89
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• 2019

Objective : This study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease. Methods : We analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro $2015^{TM}$ (TreeAge Software, Inc, Williamstown, MA, USA). Results : Patients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard. Conclusion : Both cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.