SURGICAL REVISION FOR FAILED ANTERIOR CERVICAL FUSIONS - ARTICULAR PILLAR PLATING OR ANTERIOR REVISION

Study Design, This retrospective study reviewed one surgeon's experien ce in treating symptomatic anterior cervical pseudarthrosis by three m ethods: anterior revisions, posterior revisions, and circumferential p rocedures. Objectives. To determine whether anterior revision and plat ing achieves a higher probability of radiographic fusion and better cl inical outcomes compared with posterior fusion and articular pillar pl ating. The role of circumferential procedures was evaluated. Summary o f Background Data. Management of cervical pseudarthrosis by a repeat a nterior procedure requires a difficult dissection in a previously oper ated area, resection of a nonunion site, and regrafting. Because the i ncidence of failure is reported to be high, posterior cervical fusion has been proposed as a treatment for anterior pseudarthrosis. Methods. The second author has performed 44 surgical revisions for symptomatic anterior cervical pseudarthrosis. Before this surgical revision, all patients had pain and a radiographic nonunion that was confirmed durin g surgery. The average follow-up period after the secondary procedure was 28 months with a range of 12-60 months. All patients (100%) were a vailable for follow-up evaluation. Twenty patients had anterior pseuda rthrosis repair and anterior plating. Seventeen patients underwent pos terior cervical fusion and articular pillar plating. Seven patients ha d a circumferential repair with anterior revision and posterior articu lar pillar plating. Results. All seven patients (100%) who had circumf erential procedures achieved a solid radiographic fusion. Clinically, five patients felt better than before surgery, and two patients felt t he same. Sixteen of 17 patients (94%) with posterior repairs achieved a solid fusion. Fourteen patients felt better: two patients felt the s ame, and one patient with a nonunion felt worse than before surgery. A solid fusion was obtained in only 45% of the patients after anterior repair alone. Conclusions. Posterior cervical articular pillar plating and fusion result in a higher probability of fusion than repeat anter ior procedures, even with the addition of anterior plate stabilization . Posterior fusion and articular pillar plating, whether alone or part of a circumferential procedure, provides the added fixation required to successfully repair failed anterior cervical fusions.