title: A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study.
abstract: BACKGROUND
  A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries.
  
  
  OBJECTIVE
  The recognition of the risks for these complications should be identified for timely prevention and safe treatment.
  
  
  METHODS
  
  
  
  METHODS
  Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method.
  
  
  RESULTS
  All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001.
  
  
  CONCLUSIONS
  Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.
authors.affiliation: Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ramos-Zúñiga
authors.affiliation: Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico.
authors.forename: Laura Rocío
authors.initials: LR
authors.lastname: Díaz-Guzmán
authors.affiliation: Department of Physics, Andrews University, Michigan, USA.
authors.forename: Shannen
authors.initials: S
authors.lastname: Velasquez
authors.affiliation: Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico.
authors.forename: Ana Magdalena
authors.initials: AM
authors.lastname: Macías-Ornelas
authors.affiliation: Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico.
authors.forename: Martín
authors.initials: M
authors.lastname: Rodríguez-Vázquez
keywords: Anterior cervical discectomy and fusion; dysphagia; dysphonia; soft tissue complications