Acute Radiculopathy After Anterior Cervical Discectomy and Fusion of Cervical Spondylotic Radiculopathy with Cervical Kyphosis: Causes and Prevention.

Abstract

This study was performed to investigate the incidence and clinical features of acute radiculopathy after anterior cervical discectomy and fusion (ACDF) in patients of cervical spondylotic radiculopathy (CSR) combined with cervical kyphosis, to analyze the causes, and to identify preventive measures. We analyzed 39 ACDF patients, stratified into three kyphosis groups (n = 29) and a lordotic control group (n = 10). Kyphosis Group-1 (n = 8) had acute radiculopathy with SAP displacement; Group-2 (n = 13) had displacement without radiculopathy; Group-3 (n = 8) had neither. Analyz ed parameters included C2-C7 Cobb angle (CL), Fusion Cobb angle (FCA), foraminal dimensions (D:the diameter of foramen;H:the distance from SAP to apex of foramen;L:the distance of SAP displacement), disc space height (DSH), and clinical outcomes. Compared to controls, the kyphosis groups exhibited larger CL and FCA corrections. Postoperative improvements in D, H, and L were superior in Kyphosis Group-1 and Kyphosis Group-2 over both Kyphosis Group-3 and Control group, with Kyphosis Group-1 showing greater changes in D and L than Kyphosis Group-2.The post-ACDF increase in DSH was higher in kyphosis groups and decreased sequentially from Kyphosis Group-1 to Kyphosis Group-3. A moderate positive correlation was found between the increase in DSH and L (r = 0.43, P = 0.005).Facet joint over-distraction was exclusive to Kyphosis Groups-1 and Kyphosis Groups-2, with a markedly higher incidence in Kyphosis Group-1 (5/8 vs. 2/13). Excessive intervertebral distraction during ACDF can cause acute radiculopathy. This leads to vertebral rotation and SAP displacement, resulting in iatrogenic foraminal stenosis. Selecting a properly sized cage is a key preventive measure.