Retrospective review of 1015 consecutive first-time ACDF patients at a single institution over 3 years. The study characterizes incidence, presentation, and management of the full spectrum of ACDF complications using a Smith-Robinson approach with or without anterior plate fixation. Mean follow-up was 26.4 months.
A post-ACDF patient with new dysphagia, hoarseness, or neck swelling needs an immediate, structured differential: wound hematoma (urgent re-exploration in ~2%), RLN palsy (conservative — all cases in this series resolved within 12 weeks), and esophageal perforation if fever develops.
When you see fever on postoperative day 2 after ACDF, get a chest radiograph and CT. Widened mediastinum after ACDF means esophageal perforation until proven otherwise. This paper's single death resulted from delayed recognition and subsequent mediastinitis.
Counsel patients before multilevel ACDF: 3-level procedures carry statistically higher dysphagia risk (P=0.01), likely from the wider soft tissue dissection required.
For any patient who had prior ACDF and needs another neck operation, get preoperative laryngoscopy. This paper shows that 3 of 19 patients with 'resolved' RLN palsy still had subclinical unilateral palsy on laryngoscopy. An unrecognized contralateral injury during reoperation could cause bilateral paralysis.
Retrospective review of 1015 consecutive first-time ACDF patients at a single institution over 3 years. The study characterizes incidence, presentation, and management of the full spectrum of ACDF complications using a Smith-Robinson approach with or without anterior plate fixation. Mean follow-up was 26.4 months.
A post-ACDF patient with new dysphagia, hoarseness, or neck swelling needs an immediate, structured differential: wound hematoma (urgent re-exploration in ~2%), RLN palsy (conservative — all cases in this series resolved within 12 weeks), and esophageal perforation if fever develops.
When you see fever on postoperative day 2 after ACDF, get a chest radiograph and CT. Widened mediastinum after ACDF means esophageal perforation until proven otherwise. This paper's single death resulted from delayed recognition and subsequent mediastinitis.
Counsel patients before multilevel ACDF: 3-level procedures carry statistically higher dysphagia risk (P=0.01), likely from the wider soft tissue dissection required.
For any patient who had prior ACDF and needs another neck operation, get preoperative laryngoscopy. This paper shows that 3 of 19 patients with 'resolved' RLN palsy still had subclinical unilateral palsy on laryngoscopy. An unrecognized contralateral injury during reoperation could cause bilateral paralysis.