Risk factors associated with reoperation in posterior cervical fusions: A large-scale retrospective analysis

• Published in: Clinical neurology and neurosurgery Vol. 195; p. 105828
• Main Authors: Woodroffe, Royce W., Helland, Logan C., Grossbach, Andrew J., Nourski, Kirill V., Hitchon, Patrick W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-08-2020; Elsevier Limited
• Subjects: Adjacent segment disease; Back surgery; Cervical myelopathy; Cervical spondylosis; Cigarette smoking; Connectors; Diabetes; Drug addiction; Electronic medical records; Infections; Neurology; Posterior cervical fusion; Revision; Revisions; Risk factors; Smoking; Statistical analysis; Surgical outcomes; Tobacco; Cervical spondylosis; Cervical myelopathy; Tobacco; Revision; Adjacent segment disease; Posterior cervical fusion; Smoking
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.105828

•The most common reason for posterior cervical fusion (PCF) reoperation is adjacent level disease.•Timing and extent of prior anterior fusion is not associated with PCF reoperation.•Fusion to C2 and fusion across the cervicothoracic junction is not associated with all-cause PCF reoperation.•Smoking is associated with all-cause need for PCF reoperation.
To identify risk factors for reoperation in patients who have undergone posterior cervical fusion (PCF).
A retrospective cohort analysis was performed of patients undergoing PCF during a 12-year period at a single institution. Demographic and surgical characteristics were collected from electronic medical records. This study addressed reoperations, from all causes, of PCF. Different strategies, including the addition of anterior fusion, were also compared.
Of the 370 patients meeting inclusion criteria there were 44 patients (11.9 %) that required a revision and of those 5 required a second revision. The most common reasons for revision were adjacent segment disease and infection, 13 (3.5 %) and 11 patients (3.0 %), respectively. There was not a higher revision rate (for any cause) for patients who had a subaxial fusion and compared with those that included C2 or those that failed to cross the cervicothoracic junction. Of patients who required reoperation, there was a statistically significant higher fraction of smokers (p =  0.023).
The risks and benefits of posterior cervical instrumentation and fusion should be thoroughly discussed with patients. This report implicates smoking as a risk factor for all-cause reoperation in patients who have had this PCF and provides surgeons with additional data regarding this complication. When possible, preoperative optimization should include smoking cessation therapy.