title: Success of junctional anterior cervical discectomy and fusion.
abstract: BACKGROUND
  Junctional breakdown has long been a consideration for surgeons when performing an arthrodesis in the cervical spine. Numerous authors have reported symptomatic junctional disease after fusion with varying degrees of reoperation. To our knowledge, there are no large series recording the fusion rate using instrumentation as an adjuvant to bone grafting.
  
  
  OBJECTIVE
  To determine the fusion rate when arthrodesis is performed in the setting of junctional stenosis using iliac crest autograft and instrumentation.
  
  
  METHODS
  This is a retrospective review performed on patients at the senior author's institution.
  
  
  METHODS
  The patient population consisted of a consecutive series of patients undergoing an elective anterior-only cervical arthrodesis for junctional stenosis.
  
  
  METHODS
  The primary outcome is a physiologic measure from dynamic radiographs. Fusion was assessed by the absence of motion and radiolucent lines at the bone graft interface.
  
  
  METHODS
  During the study period, a total of 56 consecutive patients underwent anterior treatment for junctional cervical stenosis. Forty-nine of these patients were treated with an anterior discectomy and instrumented arthrodesis using iliac crest autograft, and seven underwent a corpectomy. We retrospectively reviewed the patients' charts and radiographs to determine the fusion rate.
  
  
  RESULTS
  A solid fusion was obtained in 81.6% of patients in the study group. In patients undergoing a single-level arthrodesis adjacent to a one-level fusion, the fusion rate was 95.2%. The fusion rate significantly dropped in patients with longer preexisting fusion segments. In patients with a two- or three-level fusions preoperatively, the union rate was 81.3% and 57.1%, respectively.
  
  
  CONCLUSIONS
  Anterior cervical discectomy and arthrodesis yields a high fusion rate for cervical stenosis adjacent to a single-level fusion. A multilevel preexisting fusion segment leads to a significant decline in successfully achieving a solid adjacent fusion despite using iliac crest autograft and instrumentation.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213 USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gause
authors.forename: Rick A
authors.initials: RA
authors.lastname: Davis
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Smith
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: James D
authors.initials: JD
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome