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  • Posterior Cervical Fusion for the Treatment of Symptomatic Pseudoarthrosis After ACDF

    Final Number:

    Benjamin D. Elder MD PhD; Eric W. Sankey BS; Mohamad Bydon MD; C. Rory Goodwin MD, PhD; Allen Belzberg MD; Jean-Paul Wolinsky MD; Daniel M. Sciubba BS, MD; Ziya L. Gokaslan MD; Ali Bydon MD; Timothy F. Witham BS MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Pseudoarthrosis occurs after ~2-20% of ACDF procedures; it is unclear if posterior versus anterior revision should be pursued. In this study, we evaluate the outcomes in 22 patients with pseudoarthrosis following ACDF and revision via posterior cervical fusion (PCF).

    Methods: 22 patients with pseudoarthrosis after ACDF, between 1995 and 2013, were retrospectively reviewed. Baseline demographics, symptoms and operative data were collected. Information concerning the time to fusion failure, symptoms of pseudoarthrosis and revision method were assessed. Neck pain was evaluated via a visual analog scale (VAS). Fusion was radiographically examined. Clinical outcome was determined at last follow-up (LFU).

    Results: Thirteen females (59%) and nine (41%) males experienced pseudoarthrosis 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 pseudoarthrosis presented with progressive neck pain, with median VAS of 8 (range: 0-10), and/or myeloradiculopathy. Patients with pseudoarthrosis <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 (p=0.006). Pseudoarthrosis was corrected in all patients via PCF of a median of 4 (range: 1-8) levels. Fusion was successful after PCF in all patients, with mean time to fusion of 9.2 (2-14) months. Eighteen patients fused anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS was 4 (range: 1-8), at a median of 12 (range: 2-146) months follow-up; significantly improved from the time of pseudoarthrosis (p=0.012). Symptoms completely resolved/improved in 18 (82%) patients by LFU.

    Conclusions: While uncommon, pseudoarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudoarthrosis after posterior stabilization. Neck pain significantly improved by last follow-up in the majority of patients in this study.

    Patient Care: This abstract will help guide clinicians on the expected clinical outcomes when managing patients with symptomatic pseudoarthrosis after ACDF procedures, when revised with a posterior cervical fusion.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the management of pseudoarthrosis following ACDF; 2) discuss the expected outcomes of a posterior revision for ACDF pseudoarthrosis.


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