What is the most common postoperative complication of ACDF?

Answered by Randy McIntyre

The most common postoperative complication of ACDF (Anterior Cervical Discectomy and Fusion) is dysphagia, which refers to difficulty or discomfort in swallowing. This complication occurs due to the surgical manipulation of the structures in the neck, including the esophagus, during the procedure.

Dysphagia can range from mild discomfort to severe difficulty in swallowing both liquids and solids. It usually resolves within a few days to weeks after the surgery, but in some cases, it may persist for a longer duration. Patients may be advised to follow a soft or liquid diet during the initial recovery period to minimize discomfort.

Another potential complication is hoarseness or voice changes. This is typically caused by irritation or injury to the recurrent laryngeal nerve, which controls the movement of the vocal cords. The nerve can be affected during the surgery due to its close proximity to the surgical site. Hoarseness may resolve spontaneously within a few weeks, but in some cases, it may require further evaluation and treatment.

In rare cases, patients may experience difficulty breathing or shortness of breath after ACDF surgery. This can occur due to swelling or compression of the airway structures during the procedure. It is important to notify the healthcare provider immediately if any breathing difficulties are experienced.

Other potential complications of ACDF surgery include infection, bleeding, and hematoma formation. Infection can occur at the surgical site and may require antibiotic treatment. Bleeding can occur during or after the surgery and may require intervention to control the bleeding. Hematoma, which is a collection of blood, can also develop and compress nearby structures, causing pain or difficulty in swallowing or breathing.

There is also a risk of nerve root damage or injury to the spinal cord during surgery, although these complications are relatively rare. Damage to the nerves or spinal cord can result in weakness, numbness, or even paralysis. The surgeon takes precautions to minimize the risk of these complications, such as using intraoperative neuromonitoring techniques to assess nerve function during the procedure.

Additionally, there is a small risk of dural tear or spinal fluid leak during ACDF surgery. The dura is a protective covering of the spinal cord and nerves, and if it is inadvertently torn, cerebrospinal fluid (CSF) can leak out. This can lead to headaches, infection, or other complications. In most cases, dural tears can be repaired during the surgery.

It is important to note that while these complications are potential risks of ACDF surgery, they do not occur in every case. The overall complication rate for ACDF surgery is relatively low, and most patients experience a successful recovery with resolution of their symptoms. However, it is essential to discuss the potential risks and benefits of the surgery with your healthcare provider before making a decision.