title: Noninfectious prevertebral soft-tissue inflammation and hematoma eliciting swelling after anterior cervical discectomy and fusion.
abstract: OBJECTIVE Anterior cervical discectomy and fusion (ACDF) procedures are performed to treat patients with cervical myelopathy or radiculopathy. Dysphagia is a post-ACDF complication. When it coincides with prevertebral space enlargement and inflammation, surgical site infection and pharyngoesophageal perforation must be considered. The association between dysphagia and prevertebral inflammation has not been reported. The authors investigated factors eliciting severe dysphagia and its relationship with prevertebral inflammation in patients who had undergone ACDF. MATERIALS The clinical data of 299 patients who underwent 307 ACDF procedures for cervical radiculopathy or myelopathy at Kushiro Kojinkai Memorial Hospital and Kushiro Neurosurgical Hospital between December 2007 and August 2014 were reviewed. RESULTS After 7 ACDF procedures (2.3%), 7 patients suffered severe prolonged and/or delayed dysphagia and odynophagia that prevented ingestion. In all 7 patients the prevertebral space was enlarged. In 5 (1.6%) the symptom was thought to be associated with prevertebral soft-tissue edema; in all 5 an inflammatory response, hyperthermia, and an increase in the white blood cell count and in C-reactive protein level was observed. After 2 procedures (0.7%), we noted prevertebral hematoma without an inflammatory response. None of the patients who had undergone 307 ACDF procedures manifested pharyngoesophageal perforation or surgical site infection. CONCLUSIONS Severe dysphagia and odynophagia are post-ACDF complications. In most instances they are attributable to prevertebral soft-tissue edema accompanied by inflammatory responses such as fever and an increase in the white blood cell count and in C-reactive protein. In other cases these anomalies are elicited by hematoma not associated with inflammation.
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.|Department of Neurosurgery, Tokushima University Hospital, Tokushima; and.|Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yagi
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Irie
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Toru
authors.initials: T
authors.lastname: Inagaki
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Tokushima University Hospital, Tokushima; and.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro.
authors.forename: Koji
authors.initials: K
authors.lastname: Saito
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology* / Q000378:metabolism; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000378:metabolism; D011843:Radiculopathy / Q000150:complications / Q000601:surgery; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods
chemical_list: D015415:Biomarkers
keywords: ACDF = anterior cervical discectomy and fusion; CRP = C-reactive protein; NSAID = nonsteroidal antiinflammatory drug; PEEK = polyetheretherketone; PVH = prevertebral hematoma; WBC = white blood cell; anterior cervical discectomy and fusion; dysphagia; pharyngoesophageal perforation; prevertebral hematoma; prevertebral soft-tissue edema