title: Treatment of anterior cervical pseudoarthrosis: posterior fusion versus anterior revision.
abstract: BACKGROUND
  Posterior fusion has been advocated as the most effective treatment of anterior cervical pseudoarthrosis. Authors cite the benefits of increased stability and avoiding the risk of dissection through anterior scar tissue. Despite these advantages, posterior fusion is a more extensive procedure from the standpoint of perioperative and postoperative recovery.
  
  
  OBJECTIVE
  The objective of this study is to compare the results of posterior fusions to revision anterior fusions for repair of anterior cervical pseudoarthrosis.
  
  
  METHODS
  This is a retrospective case series from a single institution.
  
  
  METHODS
  120 patients with nonunion documented on flexion-extension radiographs, computed tomography (CT) scan or tomograms after an anterior cervical discectomy and fusion with at least 2-year follow-up.
  
  
  METHODS
  Surgical data, status of fusion, complications, and any revision surgeries.
  
  
  METHODS
  Hospital and office records were reviewed to determine demographic data, surgical data, status of fusion, and any revision surgeries. Nonunion was confirmed during surgery.
  
  
  RESULTS
  Of the 120 patients included in the study, 27 had repeat anterior procedures and 93 had posterior procedures. The proportion of smokers, the number of surgical levels, and the average time to revision in each group were similar. The average operative time for the anterior revision surgery was 134.9 minutes (range 49 to 232 minutes) with an estimated blood loss of 102.7 cc. In the posterior revision surgery the average operative time was 138.9 minutes (range 35 to 356 minutes) and an average estimated blood loss of 282.1 cc. The patients in the anterior revision group had an average hospital stay of 2.3 days (1 to 5 days), whereas those in the posterior revision group had an average hospital stay of 4.4 days (3 to 8 days). There was a 4% complication rate in the anterior revision group and an 8% complication rate in the posterior revision group. Twelve of 27 patients (44%) in the anterior revision group, and 2 of 93 patients in the posterior revision group required a second revision surgery for persistent nonunion.
  
  
  CONCLUSIONS
  Based on these results, posterior fusion is more effective in treating anterior cervical pseudoarthrosis than revision anterior fusion. The higher fusion rate and lower incidence of repeat revision surgery offset the increased blood loss and longer recovery time associated with posterior cervical fusions.
authors.affiliation: Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. lcarreon@spinemds.com
authors.forename: Leah
authors.initials: L
authors.lastname: Carreon
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Campbell
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D011542:Pseudarthrosis / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome