Vincent C Traynelis1, Hani R Malone1, Zachary A Smith2, Wellington K Hsu2, Adam S Kanter3,4, Sheeraz A Qureshi5,6, Samuel K Cho6, Evan O Baird5, Robert E Isaacs7, Ra'Kerry K Rahman8,9, Galina Polevaya10, Justin S Smith11, Christopher Shaffrey11, P Justin Tortolani12,13, D Alex Stroh12, Paul M Arnold14, Michael G Fehlings15, Thomas E Mroz16, K Daniel Riew17,18. 1. Rush University Medical Center, Chicago, IL, USA. 2. Northwestern University, Chicago, IL, USA. 3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. University of Pittsburgh, Pittsburgh, PA, USA. 5. Mount Sinai Hospital, New York, NY, USA. 6. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 7. Duke University Medical Center, Durham, NC, USA. 8. Springfield Clinic, LLP, Springfield, IL, USA. 9. Southern Illinois University, Springfield, IL, USA. 10. Loma Linda University, Loma Linda, CA, USA. 11. University of Virginia, Charlottesville, VA, USA. 12. Medstar Union Memorial Hospital, Baltimore, MD, USA. 13. Johns Hopkins Medical Institutions, Baltimore, MD, USA. 14. Kansas University Medical Center, Kansas City, KS, USA. 15. Toronto Western Hospital, Toronto, Ontario, Canada. 16. Cleveland Clinic, Cleveland, OH, USA. 17. Columbia University, New York, NY, USA. 18. New York-Presbyterian/The Allen Hospital, New York, NY, USA.
Abstract
STUDY DESIGN: A multicenter retrospective case series. OBJECTIVE: Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication. METHODS: We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. RESULTS: In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner's syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. CONCLUSIONS: This collective experience suggests that Horner's syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels.
STUDY DESIGN: A multicenter retrospective case series. OBJECTIVE:Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication. METHODS: We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. RESULTS: In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner's syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. CONCLUSIONS: This collective experience suggests that Horner's syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels.
Authors: Ari George Chacko; Mathew Joseph; Mazda Keki Turel; Krishna Prabhu; Roy Thomas Daniel; K S Jacob Journal: Eur Spine J Date: 2012-01-11 Impact factor: 3.134