The natural course of prevertebral soft-tissue swelling after anterior cervical spine surgery; how long will it last?

Publication date: Available online 8 May 2017
Source:The Spine Journal
Author(s): Seok Woo Kim, Chulyoung Jang, Myung Ho Yang, Seonjong Lee, Je Hyun Yoo, Yoon Hae Kwak, Ji Hyo Hwang
Background contextPrevertebral soft tissue swelling (PSTS) after anterior cervical spine surgery (ACSS) has been regarded as one of the critical complications that cause airway obstruction. Still, however, no research has dealt with how PSTS returns to pre-surgery status after ACSS; most recommendations are being performed without information about its natural course, focusing on acute-phase swelling after surgery.PurposeTo examine how long post-surgery PSTS lasts and when it returns to its pre-surgery state; to analyze the actual influence of a number of factors to observe the natural progress of post-surgery PSTS.Study design/settingA prospective observational studyPatient SampleA total of 160 patients who underwent ACSS including ACDF and Cervical TDROutcome measuresThe diameter of PSTS measured at each set time point after surgeries were compared to PSTS measurements prior to surgery, and analyzed with factors influencing PSTS.MethodsAnterior/posterior diameters of the anterior soft tissue of C3 (pharyngeal airway) and C6 (laryngeal airway) were measured using simple lateral radiography at before surgery, and immediate, 2 weeks, 1, 3, 6, 12 months after surgery. The progress of post-surgery PSTS was analyzed according to patients' individual characteristics, such as age, gender, weight, BMI, smoking status, use of antiplatelet therapy, hypertension and diabetes mellitus, complaints of dysphagia along with surgical factors such as anesthesia time, operation time, numbers of involved operation segments, transfusion, estimated blood loss(EBL) and operation method. Multivariable analysis by generalized linear mixed model was used to perform additional univariable analysis on variables found to be related to PSTS. In addition, to find the post-surgery interval at which PSTS naturally stabilizes, repeated measures analysis of variance (RM-ANOVA) and Bonferroni's method were used to perform post-hoc tests. There were no sources of funding and no conflicts of interest associated with this study.ResultsFor ACDF, mean value (95% CI) of PSTS in C3 were 4.38(4.04~4.71), 10.40(9.64~11.17), 7.72(7.10~8.35), 6.24(5.74~6.69), 5.43(5.03~5.82), 5.14(4.77~5.50), 4.96(4.59~5.33) mm at each follow-up time respectively. In C6, average values (95%CI) of PSTS were 14.43(13.96~14.91), 19.18(18.59~19.77), 17.92(17.37~18.47), 16.98(16.45~17.51), 16.18(15.67~16.69), 15.95(15.50~16.40), 15.49(15.50~16.40) mm. For cervical TDR, mean value (95%CI) of PSTS in C3 were 3.67(3.45~3.89), 8.05(7.17~8.93), 5.42(4.92~5.91), 4.57(4.21~4.92), 4.12(3.99~4.36), 4.10(3.87~4.34), 3.90(3.66~4.14) mm at each follow up time respectively. In C6, average values (95%CI) of PSTS were 13.61(12.96~14.25), 16.51(15.80~17.21), 15.77(15.13~16.42), 15.24(14.61~15.87), 14.62(14.01~15.22), 14.52(13.88~15.17), 13.94(13.20~14.68) mm. It is discovered that PSTS after surgery returned to pre-surgery status within one to three months in the pharyngeal airway (C3) and within three to six months in the laryngeal airway (C6), and Gender, BMI, and surgery method (ACDF) were determined to be the factors having influence on PSTS after surgery.Conclusionsit is necessary to pay attention to PSTS and patient conditions after ACSS for at least one to six months post-surgery, depending on surgical method and operation levels



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