Complications associated with anterior cervical spine surgery: A systematic review of literature.

Introduction: Anterior cervical spine surgery has become a widely accepted approach for treating various cervical spine pathologies. Research question: This systematic review aimed to evaluate the frequency, etiology and outcomes of complications associated with anterior cervical spine surgery. Material/methods: A comprehensive literature search was conducted using multiple databases (CINAHL Plus, MEDLINE, PubMed, Scopus, and EMBASE) for peer-reviewed articles published in English from January 1st, 1989 to December 31st, 2024. Studies involving adult patients undergoing anterior cervical spine surgery were included. The quality of evidence was assessed using the Newcastle Ottawa Scale. Results: Dysphagia emerged as the most common complication, with rates varying widely (2.3 %-87.5 %) depending on timing of assessment and methodology. Other significant complications included adjacent segment disease with the range varying from 0.4 % to 32 %, recurrent laryngeal nerve palsy (0.1 %-9 %), infection (0.39 %-8.5 %), pseudarthrosis (0.25 %-31 %), esophageal perforation (0.1 %-0.45 %), vertebral artery injury (0.3 %-7.7 %), Horner's syndrome (0.06 %-0.45 %), graft failure (2.7 %-35.5 %), CSF leak (0 %-1 %), postoperative hematoma (0.21 %-7 %) and deteriorating or new neurological deficits (0.37 % -3.3). Multilevel disease, revision surgery and OPLL were associated with higher complication rate. Surgeon's experience and higher case volume were consistently correlated with lower complication rates. Discussion & conclusion: While anterior cervical spine surgery is generally safe and effective, it carries risks of various complications ranging from common but typically self-limiting to rare but potentially severe. Μinimizing these complications depends on thorough preoperative planning, careful patient selection, and proper surgical technique.