Complications of the anterior approach to the cervical spine

OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels) and, the type of procedure performed: discectomy and placement of cage and plate (D+C+P), discectomy with placement of a cage (D+C) or corpectomy with placement of cage and plate (C+C+P). All complications related to surgical approach were reported. RESULTS: We studied 34 patients, 70% male. The average age was 50 years and mean follow-up was 8 months. Eighteen percent of patients had complications, distributed as follows: dysphasia (33%) and dysphonic (67%). Among patients who developed complications, most underwent to D+C+P (83%) and no complications were found in patients where no cervical plate was used. Regarding levels, both complications were identified in patients operated to one or two levels. However, in patients operated on three levels, only dysphonia was identified. CONCLUSION: The most frequent complication was dysphonia. Patients who presented more complications were those undergoing discectomy and fusion with cage and anterior cervical plate. All cases of dysphonia were in this group. The number of accessible levels does not seem to have affected the incidence of complications.

**研究目的**：评估接受前路入路颈椎融合内固定手术患者的手术相关并发症情况。
**研究方法**：本研究为前瞻性描述性研究，实施时段为2009年1月至2010年4月。纳入所有经前路入路接受颈椎融合手术的患者，不限定术前诊断。所有手术均采用右侧前路入路。本研究评估了手术节段数（1、2或3个节段）以及手术方式：椎间盘切除术（discectomy）+融合器（cage）+钢板（plate）植入术（D+C+P）、单纯椎间盘切除术+融合器植入术（D+C），以及椎体次全切除术（corpectomy）+融合器+钢板植入术（C+C+P）。所有与手术入路相关的并发症均被记录并上报。
**研究结果**：本研究共纳入34例患者，其中男性占70%。患者平均年龄为50岁，平均随访时长为8个月。18%的患者出现相关并发症，具体构成为：吞咽困难（33%）与发音障碍（67%）。在出现并发症的患者中，83%接受了D+C+P术式；未使用颈椎钢板的患者未出现任何并发症。按手术节段划分，1或2个节段手术的患者均可出现上述两类并发症；而3个节段手术的患者仅出现发音障碍。
**研究结论**：最常见的并发症为发音障碍。并发症发生率最高的患者群体为接受椎间盘切除术+融合器+前路颈椎钢板植入术的患者，所有发音障碍病例均集中于该群体。手术节段数量似乎并未对并发症发生率造成影响。