Treatment of nonunions following anterior cervical discectomy and fusion with interspinous wiring and bone grafting

Between 1979 and 2000, 25 posterior arthrodeses were performed for repair of symptomatic nonunions following anterior discectomy and fusion. The surgical technique in all cases was an interspinous wiring with an autogenous bone graft in 20 and morselized allograft bone in five. The average follow-up was 5 years (range, 1-14 years). In all patients, the anterior pseudarthrosis progressed to a solid union as judged by an independent musculoskeletal radiologist. In 17 patients, their preoperative pain was relieved; however, of these, six developed recurrent pain caused by degeneration at an adjacent level on an average of 5 years (range, 1-14 years) after their posterior surgery. The authors propose that posterior interspinous wiring with a bone graft is a safe and efficacious method of repair of an anterior pseudarthrosis. However, patients must be cautioned that even though the pseudarthrosis can be predictably repaired by a posterior procedure, preoperative pain may not be relieved.