REVISION OF ANTERIOR CERVICAL PSEUDOARTHROSIS WITH ANTERIOR ALLOGRAFTFUSION AND PLATING

Anterior cervical discectomy and fusion is an efficacious procedure us ed to treat a variety of cervical spinal disorders, including spondylo sis, myelopathy, herniated discs, trauma, and degenerative disc diseas e. Pseudarthrosis, or failure of fusion, may be the most common compli cation of spinal fusion procedures. Nineteen consecutive patients with symptomatic pseudarthrosis following failed anterior cervical fusions were treated with anterior cervical revision using iliac crest allogr afts and either the Cervical Spine Locking Plate system (10 patients) or the Trapezial Osteosynthetic Plate system (nine patients). The mean age of the nine men and 10 women undergoing treatment was 49.1 years (range 25-72 years). Eleven patients (57.9%) exhibited pseudarthrosis at one level, six (31.5%) at two levels, and two (10.5%) at three leve ls. The indications for revision were intractable neck pain with radic ulopathy (17 patients) or myelopathy (two patients), with evidence of pseudarthrosis on plain cervical radiography as well as computerized t omography (CT) or single-photon emission computerized tomography (SPEC T) scanning, or both. All eight patients evaluated with SPECT showed i ncreased focal uptake consistent with pseudarthrosis, which was subseq uently confirmed intraoperatively in all eight. The average follow-up period was 22.4 months (range 12-42 months). Solid osseous fusion was achieved over all 28 levels in all 18 patients available for follow-up review (100%). One patient died 4 months postoperatively from myocard ial infarction related to preexisting coronary artery disease. There w ere no intraoperative complications; postoperatively, two patients (10 .5%) experienced transient hoarseness. Anterior revision of failed cer vical fusions using allograft interbody fusion material and anterior p lating is a safe and efficacious procedure. In this series, the use of allografts avoided donor site morbidity without adversely affecting f usion rates. Rigid internal fixation was achieved by means of anterior plating without increasing surgical morbidity rates. The SPECT imagin g technique has the potential to reliably confirm the diagnosis of pse udarthrosis.