Anterior cervical pseudarthrosis. Natural history and treatment.
METHODS
A retrospective study of long-term clinical outcomes in 48 patients with pseudarthroses after anterior cervical discectomy and fusion.


OBJECTIVE
To determine the natural history, risk factors, and treatment outcomes in a large population with documented pseudarthrosis after anterior cervical discectomy and fusion.


BACKGROUND
Recent reports suggest that pseudarthrosis after anterior cervical discectomy and fusion adversely affects clinical outcome. Little data regarding cervical pseudarthroses have been published, and conclusions have been drawn from reports with small patient populations and short-term follow-up periods.


METHODS
Forty-eight patients with radiographically documented pseudarthrosis after anterior cervical discectomy and fusion were studied. Patients were examined and radiographs made at regular intervals (mean follow-up, 66 months). Clinical results were based on patients' assessment of pain, prescription drug use, activity level and Odom's criteria. Clinical outcomes in patients who underwent surgical repair of the pseudarthrosis are reported.


RESULTS
Of the 48 patients, 32 (67%) with pseudarthroses were symptomatic at latest follow-up or at the time of further surgery. Of the 32 patients, 9 had a symptom-free period of at least 2 years after the anterior cervical discectomy and fusion before redeveloping cervical symptoms after a traumatic episode. Of 48 patients with pseudarthroses, 16 (33%) remained asymptomatic at a mean of 5.1 years after anterior cervical discectomy and fusion. A younger age at the time of anterior cervical discectomy and fusion increased the likelihood of the pseudarthrosis becoming symptomatic. After multiple level anterior cervical discectomy and fusion, the caudal-most operated level accounted for 82% of the pseudarthroses. Sixteen patients had an anterior repair of the pseudarthrosis, and fusion was achieved in 14. Six patients underwent posterior pseudarthrosis repair, and all healed. In patients in whom fusion was achieved with a second cervical operation, the results were excellent in 19 and good in 1.


CONCLUSIONS
A pseudarthrosis after anterior cervical discectomy and fusion is frequently associated with a poor clinical outcome. Surgical repair of the pseudarthrosis with an anterior or posterior approach seems to have a high likelihood of a successful clinical outcome.
Phillips
F M
FM
University of Chicago Spine Center, Section of Orthopaedic Surgery, Illinois, USA.
Carlson
G
G
Emery
S E
SE
Bohlman
H H
HH
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome