Postoperative complications of anterior cervical discectomy and fusion: A comprehensive systematic review and meta-analysis

Background: Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed spine procedures for different indications in the cervical spine. Various postoperative complications have been reported following the ACDF. This systematic review and meta-analysis aimed to calculate the incidence rate of different postoperative complications associated with ACDF surgery and also identify underlying risk factors for each complication. Methods: A systematic review of the literature was performed in PubMed/MEDLINE, Embase, and the Cochrane Library for observational studies published between January 1996 and March 2023 and reporting postoperative complications associated with ACDF. Randomized controlled trials and interventional investigations were not included in this study. Meta-regression was also performed using generalized linear mixed models with a binomial probability distribution on various potential predicting factors. Results: A total of 222 studies reporting the rate of complications associated with ACDF in 50,584 patients were included in the present study. The overall postoperative complication rate was 16%. The most common complications were excessive neck swelling (11.3%), pseudarthrosis (10.0%), dysphagia (9.5%), cage/graft subsidence (9.4%), worsening myelopathy (7.7%), and hoarseness (2.3%). The rate of nonhome discharge, readmission, and mortality were 13.8%, 3.7%, and 0.1% respectively. Based on meta-regression, more levels of fusion and increased age were significantly associated with an increase in the pooled overall postoperative complication rate. Moreover, the rate of some postoperative complications was significantly associated with a number of perioperative characteristics. Conclusions: To our knowledge, this study has been the most extensive meta-analysis conducted on the existing literature regarding ACDF-related complications and potential risk factors. However, future high-quality prospective studies or clinical trials are highly required to provide further evidence and also validate the present findings.