Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis.
Pseudarthrosis occurs after approximately 2-20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3-151)months after ACDF. Median age at index surgery was 51 (range: 33-67)years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0-10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p=0.013), had more frequent preoperative neurological deficits (p=0.064), and lower baseline VAS scores (p=0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2-14)months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p=0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA. Electronic address: belder4@jhmi.edu.
Benjamin D
BD
Elder
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Eric W
EW
Sankey
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Debebe
D
Theodros
Department of Neurosurgery, The Mayo Clinic, Rochester, MN, USA.
Mohamad
M
Bydon
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
C Rory
CR
Goodwin
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Sheng-Fu
SF
Lo
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Thomas A
TA
Kosztowski
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Allen J
AJ
Belzberg
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Jean-Paul
JP
Wolinsky
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Daniel M
DM
Sciubba
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA; Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA.
Ziya L
ZL
Gokaslan
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Ali
A
Bydon
Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
Timothy F
TF
Witham
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D011542:Pseudarthrosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
Adjacent segment disease; Anterior cervical discectomy and fusion; Myelopathy; Neck pain; Posterior cervical fusion; Pseudarthrosis; Radiculopathy