ANTERIOR CERVICAL PSEUDOARTHROSIS - NATURAL-HISTORY AND TREATMENT

Study Design. A retrospective study of long-term clinical outcomes in 48 patients with pseudarthroses after anterior cervical discectomy and fusion. Objectives. To determine the natural history, risk factors, a nd treatment outcomes in a large population with documented pseudarthr osis after anterior cervical discectomy and fusion. Summary of Backgro und Data. Recent reports suggest that pseudarthrosis after anterior ce rvical discectomy and fusion adversely affects clinical outcome. Littl e data regarding cervical pseudarthroses have been published, and conc lusions have been drawn from reports with small patient populations an d short-term follow-up periods. Methods. Forty-eight patients with rad iographically documented pseudarthrosis after anterior cervical discec tomy and fusion were studied. Patients were examined and radiographs m ade at regular intervals (mean follow-up, 66 months). Clinical results were based on patients' assessment of pain, prescription drug use, ac tivity level and Odom's criteria. Clinical outcomes in patients who un derwent surgical repair of the pseudarthrosis are reported. Results. O f the 48 patients, 32 (67%) with pseudarthroses were symptomatic at la test follow-up or at the lime of further surgery. Of the 32 patients, 9 had a symptom-free period of at least 2 years after the anterior cer vical discectomy and fusion before redeveloping cervical symptoms afte r a traumatic episode. Of 48 patients with pseudarthroses, 16 (33%) re mained asymptomatic at a mean of 5.1 years after anterior cervical dis cectomy and fusion. A younger age at the time of anterior cervical dis cectomy and fusion increased the likelihood of the pseudarthrosis beco ming symptomatic. After multiple level anterior cervical discectomy an d fusion, the caudal-most operated level accounted for 82% of the pseu darthroses. Sixteen patients had an anterior repair of the pseudarthro sis, and fusion was achieved in 14. Six patients underwent posterior p seudarthrosis repair, and all healed. In patients in whom fusion was a chieved with a second cervical operation, the results were excellent i n 19 and good in 1. Conclusion. A pseudarthrosis after anterior cervic al discectomy and fusion is frequently associated with a poor clinical outcome. Surgical repair of the pseudarthrosis with an anterior or po sterior approach seems to have a high likelihood of a successful clini cal outcome.