Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: K. Siemionow

Author(s):

K. Siemionow(1), P. Glowka(1,2), W. Smith(3), M. Gillespy(4), J. Huffman(5), V. Vong(6)

(1) University of Illinois at Chicago, Department of Orthopaedics, Chicago, IL, United States
(2) University of Medical Sciences, Department of Spinal Disorders and Pediatric Orthopaedics, Poznan, Poland
(3) Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, United States
(4) Orthopaedic Clinic of Daytona Beach, Daytona Beach, FL, United States
(5) Napa Valley Orthopaedics, Napa, CA, United States
(6) University of California, San Francisco, CA, United States

Abstract

Background: Pseudarthrosis after anterior cervical discectomy and fusion (ACDF) causes persistent pain and related disability. Posterior revision surgery results in higher healing rates, but is more extensive compared to anterior surgery. To evaluate minimally disruptive, tissue sparing posterior fusion via bilateral placement of posterior cages between the facet joints as an alternative treatment option.

Methods: A retrospective, multicenter, medical chart review was performed and included 25 patients with symptomatic pseudarthrosis after ACDF treated with posterior cervical cages, and in select cases, anterior revision. Visual analog scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and perioperative metrics were collected. Fusion at 1 yr was determined via assessment of computed tomography (CT) scan and x-rays.

Results: Mean follow-up was 18 mo. VAS neck and arm scores at last follow-up improved signi cantly from 7.9 ± 1.5 to 3.8 ± 2.3 and 7.24 ± 2.2 to 3.12 ± 2.5, respectively. NDI scores decreased from 65.1 ± 20.3 to 29.1 ± 17.9 at 18 mo. Fusion at 1 yr was con rmed by CT in all 17 patients with available scans and by x-ray in all 25 patients.

Conclusions: Revision of cervical pseudarthrosis after ACDF using a tissue sparing posterior approach to place cages bilaterally between the facet joints is an e ective surgical strategy in select cases. Along with positive clinical and radiological outcomes, the procedure is associated with less blood loss, shorter operating times, and briefer hospital stays compared to revision with lateral mass xation or interspinous wiring.