Tracheostomy Following Anterior Cervical Discectomy and Fusion With Plating in Trauma Patients: Is It Safe?

Abstract

This study aimed to evaluate the safety and necessity of tracheostomy after anterior cervical discectomy and fusion (ACDF) with plating, despite the close proximity of the two surgical skin incisions. Sixty-three patients with traumatic cervical fractures or spinal cord injury (SCI) who underwent single-level ACDF and plating between January 2014 and June 2019 were included in this study. The patients included 45 men and 18 women, with a mean age of 48.5 years. A retrospective analysis of the patients' demographic data, level of injury, radiological findings, and neurological status was performed based on the American Spinal Injury Association (ASIA), open tracheostomy, and decannulation rate. Additionally, risk factors necessitating tracheostomy were statistically analyzed. Eighteen patients (28.5%) required subsequent open tracheostomy. Among them, 11 patients were successfully decannulated, four patients could not be decannulated during the follow-up period, and three patients died of unrelated complications. The median interval from ACDF with plating to open tracheostomy was 9.6 days (range, 5-23 days). On the basis of neurological status, ASIA A and B patients (p<0.001), high signal intensity on T2-weighted-magnetic resonance (MR) images (p=0.001), and major cervical fracture and dislocation were significant risk factors for tracheostomy (p=0.02). No patient showed evidence of significant soft tissue, bony infection, or nonunion during the follow-up period. Independent tracheostomy did not increase the risk of infection or nonunion despite the close proximity of the two surgical skin incisions.