Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis |
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| Institution: | 1. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA;2. Department of Neurosurgery, The Mayo Clinic, Rochester, MN, USA;3. Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA;1. Orthopedic Department of Changhai Hospital, Second Military Medical University, No. 168, Changhai Rd., Shanghai 200433, People’s Republic of China;2. Department of Spine Surgery, The Second Hospital of Tangshan, Tangshan, Hebei 063000, People’s Republic of China;1. Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan;2. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan;3. Shiraishi Spine Clinic, 1-5-1-1220 Marunouchi, Chiyoda, Tokyo, 100-6512, Japan;1. Department of Orthopaedic Surgery, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China;2. Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China;3. Department of Orthopaedic Surgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming, China;1. Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;2. Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA;3. Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;4. Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;5. Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA;6. Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;7. Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;8. Washington University Orthopedics, Washington University School of Medicine, 4921 Parkview Pl, St. Louis, MO 63110, USA;9. Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, 11100 Euclid Avenue, HAN 5042 Cleveland, OH 44106, USA |
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| Abstract: | Pseudarthrosis occurs after approximately 2–20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3–151) months after ACDF. Median age at index surgery was 51 (range: 33–67) years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0–10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p = 0.013), had more frequent preoperative neurological deficits (p = 0.064), and lower baseline VAS scores (p = 0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2–14) months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p = 0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study. |
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| Keywords: | Adjacent segment disease Anterior cervical discectomy and fusion Myelopathy Neck pain Posterior cervical fusion Pseudarthrosis Radiculopathy |
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