General Session: Cervical Motion Preservation

Presented by: J. Kim - View Audio/Video Presentation (Members Only)

Author(s):

R. Merrill(1), S. Overley(1), J. Kim(1), J. Dowdell(1), S. Qureshi(1), S. Cho(1)

(1) Icahn School of Medicine at Mount Sinai, New York, NY, United States

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely used technique to treat degenerative conditions of the cervical spine. Pseudarthrosis following ACDF has been reported to occur in up to 20% and 50% of single-level and multi-level procedures, respectively. The objective of this retrospective study was to investigate the presenting symptoms and radiographic features of patients undergoing revision surgery for pseudarthrosis after anterior cervical discectomy and fusion (ACDF).

Methods: We conducted a retrospective review of patients who underwent revision surgery for symptomatic pseudarthrosis following ACDF. In addition to clinical assessment and plain radiographs, magnetic resonance imaging (MRI) or computed tomography (CT) were reviewed to determine if central canal stenosis, foraminal stenosis, and/or degenerative changes were present at the index or adjacent levels.

Results: Twenty-six patients (average age 47 years) who underwent posterior spinal fusion for symptomatic pseudarthrosis following ACDF were reviewed. All 26 patients had axial neck pain (100%), and 20 (77%) had radiculopathy. On MRI or CT of the index level, central stenosis was observed in 48% of patients, foraminal stenosis was seen in 57% of patients, and both central and foraminal stenosis were present in 33% of patients. At adjacent levels, central stenosis, foraminal stenosis, and both central and foraminal stenosis was seen in 43%, 52%, and 33% of patients, respectively. Degenerative changes were found at adjacent levels above the index level in 57% of patients, below the index level in 24% of patients, and both above and below the index level in 19%. The average time to revision surgery was 17.48 months.

Conclusions: Patients who develop axial neck pain, with or without concomitant radiculopathy, several months following ACDF should be evaluated for pseudarthrosis. Additionally, residual stenosis is common at the index and adjacent levels and should be addressed at time of revision surgery.