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Normal Prevertebral Soft Tissue Swelling After Anterior Cervical Decompression and Fusion: Poster #6

Sanfilippo, James A. Jr. MD, MHS; Jacoby, Sidney M. MD; Lim, Moe R. MD; Albert, Todd J. MD; Harrop, James S. MD; Vaccaro, Alexander R. MD; Hilibrand, Alan S. MD; Anderson, David G. MD1

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Spine Journal Meeting Abstracts: 2005 - Volume - Issue 7 - p 171–172
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INTRODUCTION: Prevertebral soft tissue swelling (PSTS) has been evaluated in the setting of traumatic cervical spine injuries. However, no study to date has quantified the prevertebral soft tissue swelling following elective anterior cervical decompression and fusion (ACDF) or the time course to resolution of that swelling.

METHODS: From 5/2002 to 5/2005 the senior author (TJA) performed 193 elective 1‐ or 2‐level ACDFs. Patients who underwent corpectomies and anterior cervical fusions for trauma or tumor were excluded. Pre‐operative, 2‐week postoperative and 6‐week post‐operative radiographs were available on 110 patients. The prevertebral soft tissue swelling was measured on the neutral lateral radiographs for the three time points. The mean swelling (mm) for each time point was calculated and stratified by cervical level and by the operative level. Repeated measures analysis of variance with the Tukey‐Kramer multiple comparisons test was used to compare the measured swelling at the various time points.

RESULTS: The average prevertebral soft tissue swelling was calculated for each cervical level, for each of the three time points, pre‐operative, 2‐week and 6‐week post‐operative. The average PSTS at C2 was 4.2 mm, 5.2 mm, and 4.6 mm at pre‐op, 2 weeks, and 6 weeks, respectively; at C3, 4.9 mm, 7.3 mm, and 5.4 mm; at C4, 7.0 mm, 10.7 mm, and 7.9 mm; at C5, 12.3 mm, 18.4 mm, and 13.5 mm; at C6, 15.1 mm, 21.1 mm, and 17.6 mm; and at C7, 14.8 mm, 20.0 mm, and 17.3 mm. There was a statistically significant increase in PSTS between the pre‐operative and 2‐week post‐operative measurements at the operative level and the adjacent cephalad and caudal levels. There is a significant decrease in PSTS between 2‐ and 6‐week post‐operatively at the operative level, at one level cephalad, and at one level caudal. There is no significant change in PSTS at any level, when comparing the pre‐operative and 6 week post‐operative measurements.

CONCLUSIONS: The “normal” range for prevertebral soft tissue swelling at 2 weeks and at 6 weeks after elective 1‐ and 2‐ level ACDFs is described. Our data demonstrates that significant edema persists at the 2‐week follow‐up. By 6‐weeks post‐operative, this increase in PSTS has significantly dissipated.

If noted, the author indicates something of value received. The codes are identified as: a‐ research or institutional support; b‐ miscellaneous funding; c‐ royalties; d‐ stock options; e‐ consultant or employee; n‐ no conflicts disclosed, and * disclosure not available at the time of printing. For full information, refer to inside of back cover.

© 2005 Lippincott Williams & Wilkins, Inc.