Download PDF
Semin Plast Surg 2021; 35(01): 010-013
DOI: 10.1055/s-0041-1722853
Review Article

Failure in Cervical Spinal Fusion and Current Management Modalities

Terence Verla
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
,
David S. Xu
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
,
Matthew J. Davis
2   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Edward M. Reece
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Michelle Kelly
2   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Mervin Nunez
2   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Sebastian J. Winocour
2   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Alexander E. Ropper
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Failed fusion in the cervical spine is a multifactorial problem stemming from a combination of patient and surgical factors. Patient-related risk factors such as steroid use, poor bone quality, and smoking can be optimized preoperatively. Age, prior radiation, prior surgery, and underlying genetics are nonmodifiable patient-centered risk factors. Surgical risks for failed fusion include the number of segments fused, anterior versus posterior approach for fusion, the type of bone graft, and the instrumentation utilized. Many symptomatic cases of failed fusion (pseudarthrosis) result in pain, neurological deficits, or loosened hardware necessitating a revision surgery consisting of extending the prior construct and utilizing additional allografts or autografts to augment the fusion. Given the relatively mobile nature of the cervical spine, pseudoarthrosis (either known or anticipated) must be recognized by the spine surgeon, and steps should be considered to optimize the likelihood of future fusion. This consists of both performing a rigid fixation and using appropriate bone graft to enhance the environment for arthrodesis. Vascularized bone grafts are a useful tool to augment fusion and provide added structural stability in cases at high risk of pseudoarthrosis.

Keywords

cervical pseudarthrosis - spinoplastic reconstruction - neurosurgery - spine surgery - plastic surgery


Publication History

Article published online:
10 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Saifi C, Fein AW, Cazzulino A. et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J 2018; 18 (06) 1022-1029
    CrossrefPubMedGoogle Scholar
  • 2 Pennington Z, Mehta VA, Lubelski D. et al. Quality of life and cost implications of pseudarthrosis after anterior cervical discectomy and fusion and its subsequent revision surgery. World Neurosurg 2020; 133: e592-e599
    CrossrefPubMedGoogle Scholar
  • 3 Lowery GL, Swank ML, McDonough RF. Surgical revision for failed anterior cervical fusions. Articular pillar plating or anterior revision?. Spine 1995; 20 (22) 2436-2441
    CrossrefPubMedGoogle Scholar
  • 4 Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE. Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine 2003; 28 (01) 46-51
    CrossrefPubMedGoogle Scholar
  • 5 Phillips FM, Carlson G, Emery SE, Bohlman HH. Anterior cervical pseudarthrosis. Natural history and treatment. Spine 1997; 22 (14) 1585-1589
    CrossrefPubMedGoogle Scholar
  • 6 Bolesta MJ, Rechtine II GR, Chrin AM. One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J 2002; 2 (03) 197-203
    CrossrefPubMedGoogle Scholar
  • 7 Hilibrand AS, Fye MA, Emery SE, Palumbo MA, Bohlman HH. Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 2001; 83 (05) 668-673
    CrossrefPubMedGoogle Scholar
  • 8 Lau D, Chou D, Ziewacz JE, Mummaneni PV. The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy: clinical article. J Neurosurg Spine 2014; 21 (04) 547-558
    CrossrefPubMedGoogle Scholar
  • 9 Samartzis D, Shen FH, Matthews DK, Yoon ST, Goldberg EJ, An HS. Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation. Spine J 2003; 3 (06) 451-459
    CrossrefPubMedGoogle Scholar
  • 10 Wang JC, McDonough PW, Endow KK, Delamarter RB. Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 2000; 25 (01) 41-45
    CrossrefPubMedGoogle Scholar
  • 11 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 2001; 26 (06) 643-646 , discussion 646–647
    CrossrefPubMedGoogle Scholar
  • 12 Brodsky AE, Khalil MA, Sassard WR, Newman BP. Repair of symptomatic pseudoarthrosis of anterior cervical fusion. Posterior versus anterior repair. Spine 1992; 17 (10) 1137-1143
    CrossrefPubMedGoogle Scholar
  • 13 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 1990; 72 (08) 1171-1177
    CrossrefPubMedGoogle Scholar
  • 14 Kuhns CA, Geck MJ, Wang JC, Delamarter RB. An outcomes analysis of the treatment of cervical pseudarthrosis with posterior fusion. Spine 2005; 30 (21) 2424-2429
    CrossrefPubMedGoogle Scholar