FAILED ANTERIOR CERVICAL DISKECTOMY AND ARTHRODESIS - ANALYSIS AND TREATMENT OF 35 PATIENTS

Thirty-five patients were managed operatively after failure of an ante rior cervical discectomy and arthrodesis. Failure was classified as th e absence of fusion without deformity but with neck pain or radiculopa thy, or both; the absence of fusion after anterior or posterior dislod gment of the graft; or kyphosis due to collapse of the graft or to an unrecognized posterior soft-tissue injury. Twenty-three patients had f ailure of the arthrodesis without deformity (with neck pain only, neck and arm pain, radiculopathy, or myelopathy). Four patients had dislod gment of the graft; in two of them the graft migrated anteriorly after a multilevel Robinson arthrodesis, and in two it migrated posteriorly after a Cloward arthrodesis, Eight patients had a failure because of a kyphotic deformity. Five of them had had a Cloward arthrodesis; one, a discectomy; and two, a Robinson arthrodesis. Six had received allog raft bone. Operative treatment of the pseudarthrosis consisted of repe at resection of the disc space in the area of the failed arthrodesis f ollowed by repeat anterior Robinson arthrodesis with decompression of the nerve root if the patient had radiculopathy. It consisted of anter ior corpectomy or vertebral-body resection and strut-grafting with red uction of the deformity if the patient had migration of the graft and kyphosis. The reoperations were performed four months to fourteen year s (average, thirty-two months) after the initial operation, The durati on of follow-up after the second operation averaged forty-four months (range, twenty-four to 216 months). The result was excellent for twent y-nine patients, good for one, fair for four, and poor for one. We con cluded that, in patients who have persistent symptoms after an anterio r cervical arthrodesis, an excellent result can be achieved with repea t anterior decompression and autogenous bone-grafting.