Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis

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 revi...

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Published in:	Journal of clinical neuroscience Vol. 24; pp. 57 - 62
Main Authors:	Elder, Benjamin D, Sankey, Eric W, Theodros, Debebe, Bydon, Mohamad, Rory Goodwin, C, Lo, Sheng-Fu, Kosztowski, Thomas A, Belzberg, Allen J, Wolinsky, Jean-Paul, Sciubba, Daniel M, Gokaslan, Ziya L, Bydon, Ali, Witham, Timothy F
Format:	Journal Article
Language:	English
Published:	Scotland 01-02-2016
Subjects:	Adult Aged Cervical Vertebrae - surgery Diskectomy - adverse effects Diskectomy - methods Female Humans Male Middle Aged Neck Pain - etiology Neurology Pseudarthrosis - etiology Pseudarthrosis - surgery Reoperation Retrospective Studies Spinal Fusion - adverse effects Spinal Fusion - methods Treatment Outcome Neck pain Myelopathy Anterior cervical discectomy and fusion Adjacent segment disease Pseudarthrosis Radiculopathy Posterior cervical fusion
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0967-5868 1532-2653
DOI:	10.1016/j.jocn.2015.07.019