Management of anterior cervical pseudarthrosis

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  • 1 Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;
  • | 2 Department of Neurosurgery, University of California at San Francisco, California;
  • | 3 Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;
  • | 4 Departments of Orthopaedic Surgery and
  • | 11 Neurological Surgery, University of Wisconsin, Madison, Wisconsin;
  • | 5 Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • | 6 Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;
  • | 7 Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;
  • | 8 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • | 9 Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and
  • | 10 Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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Object

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.

Abbreviations used in this paper:

ACDF = anterior cervical discectomy and fusion; CSOQ = Cervical Spine Outcome Questionnaire; SF-36 = 36-Item Short Form Health Survey.

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  • 1

    Angevine PD, , Arons RR, & McCormick PC: National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990–1999. Spine 28:931939, 2003

    • Search Google Scholar
    • Export Citation
  • 2

    Bohlman HH, , Emery SE, , Goodfellow DB, & Jones PK: Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:12981307, 1993

    • Search Google Scholar
    • Export Citation
  • 3

    Brodsky AE, , Khalil MA, , Sassard WR, & Newman BP: Repair of symptomatic pseudarthrosis of anterior cervical fusion. Posterior versus anterior repair. Spine 17:11371143, 1992

    • Search Google Scholar
    • Export Citation
  • 4

    Brunton FJ, , Wilkinson JA, , Wise KS, & Simonis RB: Cine radiography in cervical spondylosis as a means of determining the level for anterior fusion. J Bone Joint Surg Br 64:399404, 1982

    • Search Google Scholar
    • Export Citation
  • 5

    Carreon L, , Glassman SD, & Campbell MJ: Treatment of anterior cervical pseudarthrosis: posterior fusion versus anterior revision. Spine J 6:154156, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    Connolly ES, , Seymour RJ, & Adams JE: Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg 23:431437, 1965

    • Search Google Scholar
    • Export Citation
  • 7

    Coric D, , Branch CL Jr, & Jenkins JD: Revision of anterior cervical pseudarthrosis with anterior allograft fusion and plating. J Neurosurg 86:969974, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    De Palma AF, & Cooke AJ: Results of anterior interbody fusion of the cervical spine. Clin Orthop Relat Res 60:169185, 1968

  • 9

    Farey ID, , McAfee PC, , Davis RF, & Long DM: Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis. J Bone Joint Surg Am 72:11711177, 1990

    • Search Google Scholar
    • Export Citation
  • 10

    Fuji T, , Yonenobu K, , Fujiwara K, , Yamashita K, , Ono K, & Okada K: Interspinous wiring without bone grafting for nonunion or delayed union following anterior spinal fusion of the cervical spine. Spine 11:982987, 1986

    • Search Google Scholar
    • Export Citation
  • 11

    Kaiser MG, , Haid RW Jr, , Subach BR, , Barnes B, & Rodts GE Jr: Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229236, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Kuhns CA, , Geck MJ, , Wang JC, & Delamarter RB: An outcomes analysis of the treatment of cervical pseudarthrosis with posterior fusion. Spine 30:24242429, 2005

    • Search Google Scholar
    • Export Citation
  • 13

    Lindsey RW, , Newhouse KE, , Leach J, & Murphy MJ: Nonunion following two-level anterior cervical discectomy and fusion. Clin Orthop Relat Res 223:155163, 1987

    • Search Google Scholar
    • Export Citation
  • 14

    Lowery GL, , Swank ML, & McDonough RF: Surgical revision for failed anterior cervical fusions. Articular pillar plating or anterior revision?. Spine 20:24362441, 1995

    • Search Google Scholar
    • Export Citation
  • 15

    Martin GJ Jr, , Haid RW Jr, , MacMillan M, , Rodts GE Jr, & Berkman R: Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine 24:852858, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Neo M, , Fujibayashi S, , Yoshida M, & Nakamura T: Spinous process plate fixation as a salvage operation for failed anterior cervical fusion. Technical note. J Neurosurg Spine 4:7881, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Newman M: The outcome of pseudarthrosis after cervical anterior fusion. Spine 18:23802382, 1993

  • 18

    Phillips FM, , Carlson G, , Emery SE, & Bohlman HH: Anterior cervical pseudarthrosis. Natural history and treatment. Spine 22:15851589, 1997

    • Search Google Scholar
    • Export Citation
  • 19

    Prolo DJ, , Oklund SA, & Butcher M: Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11:601606, 1986

    • Search Google Scholar
    • Export Citation
  • 20

    Riley LH Jr, , Robinson RA, , Johnson KA, & Walker AE: The results of anterior interbody fusion of the cervical spine. Review of ninety-three consecutive cases. J Neurosurg 30:127133, 1969

    • Search Google Scholar
    • Export Citation
  • 21

    Shinomiya K, , Okamoto A, , Kamikozuru M, , Furuya K, & Yamaura I: An analysis of failures in primary cervical anterior spinal cord decompression and fusion. J Spinal Disord 6:277288, 1993

    • Search Google Scholar
    • Export Citation
  • 22

    Siambanes D, & Miz GS: Treatment of symptomatic anterior cervical nonunion using the Rogers interspinous wiring technique. Am J Orthop 27:792796, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Tribus CB, , Corteen DP, & Zdeblick TA: The efficacy of anterior cervical plating in the management of symptomatic pseudarthrosis of the cervical spine. Spine 24:860864, 1999

    • Search Google Scholar
    • Export Citation
  • 24

    Wang JC, , McDonough PW, , Endow KK, & Delamarter RB: Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 25:4145, 2000

    • Search Google Scholar
    • Export Citation
  • 25

    Wang JC, , McDonough PW, , Kanim LE, , Endow KK, & Delamarter RB: Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 26:643646, 2001

    • Search Google Scholar
    • Export Citation
  • 26

    White AA III, , Southwick WO, , Deponte RJ, , Gainor JW, & Hardy R: Relief of pain by anterior cervical-spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg Am 55:525534, 1973

    • Search Google Scholar
    • Export Citation
  • 27

    Zdeblick TA, , Hughes SS, , Riew KD, & Bohlman HH: Failed anterior cervical discectomy and arthrodesis. Analysis and treatment of thirty-five patients. J Bone Joint Surg Am 79:523532, 1997

    • Search Google Scholar
    • Export Citation

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