PRISMA-compliant systematic review of 240 studies (1989–2019) characterizing complications of anterior-only cervical spine surgery in adults. Covers incidence, etiology, risk factors, and management for the full spectrum of complications — from dysphagia to vertebral artery injury. Provides pooled rates across retrospective and prospective data to establish consent-ready benchmarks.
The complication rates from retrospective series — historically the dominant source in consent discussions. Substantially undercount dysphagia. When counseling patients, use prospective benchmarks: approximately 11% will have some dysphagia postoperatively, and roughly 10% may have symptoms lasting beyond 3 months.
When you see a patient on postoperative day 1–2 after ACDF with new deltoid weakness, think C5 palsy before thinking hardware failure or hematoma. It characteristically appears at a mean of 1.7 days. Check preoperative imaging for cord rotation. Rotation ≥10° flags elevated risk.
Cervical hematoma demands a low threshold for return to the OR. Nearly half of all hematomas require surgical evacuation, and the window before airway compromise narrows quickly. Flag your highest-risk patients preoperatively: multilevel surgery, INR >1.2, BMI <24, and ASA ≥3 are independent predictors.
Esophageal perforation can present years or decades after surgery with sepsis, aspiration pneumonia, or even meningitis. When a patient with remote anterior cervical surgery presents with any of these findings, esophageal perforation belongs on the differential regardless of time elapsed since the index operation.
PRISMA-compliant systematic review of 240 studies (1989–2019) characterizing complications of anterior-only cervical spine surgery in adults. Covers incidence, etiology, risk factors, and management for the full spectrum of complications — from dysphagia to vertebral artery injury. Provides pooled rates across retrospective and prospective data to establish consent-ready benchmarks.
The complication rates from retrospective series — historically the dominant source in consent discussions. Substantially undercount dysphagia. When counseling patients, use prospective benchmarks: approximately 11% will have some dysphagia postoperatively, and roughly 10% may have symptoms lasting beyond 3 months.
When you see a patient on postoperative day 1–2 after ACDF with new deltoid weakness, think C5 palsy before thinking hardware failure or hematoma. It characteristically appears at a mean of 1.7 days. Check preoperative imaging for cord rotation. Rotation ≥10° flags elevated risk.
Cervical hematoma demands a low threshold for return to the OR. Nearly half of all hematomas require surgical evacuation, and the window before airway compromise narrows quickly. Flag your highest-risk patients preoperatively: multilevel surgery, INR >1.2, BMI <24, and ASA ≥3 are independent predictors.
Esophageal perforation can present years or decades after surgery with sepsis, aspiration pneumonia, or even meningitis. When a patient with remote anterior cervical surgery presents with any of these findings, esophageal perforation belongs on the differential regardless of time elapsed since the index operation.