title: Early and late re-operations after anterior cervical decompression and fusion during an 11-year follow-up.
abstract: BACKGROUND
  Anterior cervical decompression and fusion (ACDF) may necessitate acute and late re-operations. Published long-term follow studies after ACDF are scarce.
  
  
  OBJECTIVE
  Our goal was to give a detailed description of early and late re-operations after ACDF in an 11-year follow-up.
  
  
  METHODS
  We retrospectively analyzed all available clinical data, including radiographic imaging for all patients who underwent an ACDF at our institution between 1998 and 1999. ACDF without plating was performed in 327 patients. All re-operations were performed at our institution.
  
  
  RESULTS
  Forty-nine patients (15 %, CI 12-19 %) underwent a re-operation; 16 (4.9 %, CI 3-8 %) during the first month and 36 (11 %, CI 8-15 %) later during the follow-up. Five early re-operations were due to postoperative hematomas. No anterior transition of cages was detected. Asymptomatic cage subsidence was seen in 21 re-operated patients, but only one (0.3 %, CI 0-2 %) resulted in a re-operation. Adjacent level re-operation was performed for 26 patients (8 %, CI 5-11 %). This was independent of the number of fused levels or the localization of fusion. Plate reinforcement was used in only two patients in addition to ACDF; both of them were re-operations. The outcome was reported good or excellent for 11 (69 %, CI 44-86 %) and 26 (72 %, CI 56-84 %) patients with an early and late re-operation, respectively.
  
  
  CONCLUSIONS
  Fifteen percent of patients underwent a re-operation during the follow-up. The outcome for re-operated patients is similar to patients without a re-operation. A multilevel fusion does not predispose to adjacent level degeneration. A solid fusion can be achieved without plating.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland. tuure.saarinen@helsinki.fi
authors.forename: Tuure
authors.initials: T
authors.lastname: Saarinen
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.forename: Janne
authors.initials: J
authors.lastname: Pitkäniemi
authors.forename: Juha
authors.initials: J
authors.lastname: Pohjola
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion; D055009:Spondylosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome