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Perioperative Complications of Combined Anterior and Posterior Cervical Decompression and Fusion Crossing the Cervico-Thoracic Junction

Study Design. Retrospective review. Objective. To determine the perioperative complications for patients undergoing single stage, multilevel, anterior, and posterior cervical fusions crossing the cervico-thoracic junction. Summary of Background Data. Cervical spinal stenosis with kyphosis involving 3 or more disc levels is often treated via combined anterior decompression and posterior instrumented fusion. When long cervical fusions end at C7, many surgeons extend the posterior fusion across the cervico-thoracic junction to reduce the potential for adjacent segment breakdown. Perioperative complications associated with these procedures have not previously been described. Methods. A retrospective review of perioperative complications occurring in patients undergoing combined anterior decompression and posterior instrumented arthrodesis crossing the cervico-thoracic junction. The effect of operative time, blood loss, and fluid replacement on the need for extended intubation was tested with a Fisher exact test. Results. Thirteen patients fit the inclusion criteria. Nine patients experienced at least 1 complication (69%, 9/13) during the perioperative period, comprising 16 minor and 5 major complications. The most common complications were dysphagia (46%, 6/19) and airway edema requiring extended intubation (38%, 5/13). Conclusion. Complications are frequent following these procedures, although the majority were minor and resolved without lasting effect. Airway edema requiring prolonged intubation or reintubation was frequent. With the numbers available, we were unable to show a relationship between the need for extended intubation and variables including operative time, blood loss, or volume of fluid replacement.