Causes of same-route reoperations in degenerative cervical spine disease after a primary anterior approach

Abstract

Introduction: An anterior approach is most commonly used in procedures performed in cases of degenerative cervical spine disease (DCSD). Although generally considered safe, they are not free of complications that may result in the need for reoperation. The aim of the study is to analyse causes of reoperation via the same approach for DCSD in patients who have previously undergone one of the anterior cervical approaches.

Materials and methods: Of the 2,794 patients managed with a surgical procedure performed from an anterior approach, a total of 38 were reoperated on via the same anterior route between year 2004–2019 at a single tertiary centre. Retrospective assessment was conducted based on medical records and radiological imaging. Subjects were grouped into 2 categories: early revision surgeries (within 90 days of the 1st procedure) and late revision surgeries (after 90 days).

Results: The incidence of same-route reoperation was 1.36%. Late reoperations were over twice as frequent as early ones (n = 26 vs n = 12). The main cause for reoperation in the late group was adjacent segment disease (ASD; n = 25, 96.15%) whereas in the early group, persistent stenosis and implant dislocation were equally prevalent (each n = 3, 27.3%). The reoperations which were conducted earliest were due to emergent post-operative prevertebral hematomas (n = 2, 16.67%).

Conclusion: The risk of needing a same-route reoperation after anterior approaches in DCSD is relatively low with late revisions being more prevalent. Adjacent segment disease is the most common cause. Implant dislocation as well as persistent spinal canal stenosis are the main causes behind early revisions.