Management of Symptomatic Cervical Spine Pseudarthrosis: A Suggested Algorithm for Surgical Planning

Abstract

Background: The clinical outcome of anterior cervical decompression and fusion (ACDF) correlates with fusion rates. There is a debate about how patients with symptomatic pseudarthrosis should be managed. In this study, a treatment plan is developed based on the surgical results of 95 patients and the recent literature. Methods: A retrospective study to evaluate the long-term results after surgical treatment of symptomatic pseudarthrosis after ACDF. Between 1994 and 2015, 95 patients underwent surgery due to symptomatic pseudarthrosis after ACDF. The diagnosis was confirmed with dynamic radiographs and computed tomography scans. The approach used was anterior in 62 (65.1%), posterior in 13 (13.7%), and combined anterior and posterior in 20 (21.2%) patients. The operative details and the radiological and clinical results were analyzed. Results: The primary operation was fusion using cages in 70, bone graft and plate in 16, and bone graft only in 9 patients. The revision was performed after a mean of 27 months. After a mean follow-up of 52 months, the mean Visual Analog Scale improved from 7.5 to 2.3 (P = 0.001), and the mean Neck Disability index improved from 26.4 to 8.7 (P = 0.034). Fusion was achieved in all patients after a mean of 7.8 (SD 2.9) months. Reoperation was indicated in 4 patients, all of whom were in the anterior-only group, and was due to retropharyngeal hematoma in 1 patient and cage sinking with kyphosis in 3 patients. Conclusions: Solid arthrodesis significantly improves the symptoms of cervical pseudarthrosis patients. The presence of adjacent segment disease, implant migration, residual stenosis, and segmental kyphosis plays an important role in decision-making. A treatment recommendation plan has been suggested.