Management of anterior cervical pseudarthrosis.
OBJECTIVE
The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis.


METHODS
The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.


RESULTS
Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III).


CONCLUSIONS
If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.
Kaiser
Michael G
MG
Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York, USA.
Mummaneni
Praveen V
PV
Matz
Paul G
PG
Anderson
Paul A
PA
Groff
Michael W
MW
Heary
Robert F
RF
Holly
Langston T
LT
Ryken
Timothy C
TC
Choudhri
Tanvir F
TF
Vresilovic
Edward J
EJ
Resnick
Daniel K
DK
D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D011542:Pseudarthrosis / Q000175:diagnosis* / Q000601:surgery*