Highlights
- •Pseudarthrosis rates of extended anterior cervical fusion (3- and 4-level) are under-reported.
- •The minority of radiographic pseudarthrosis are clinically symptomatic.
- •Pseudarthrosis rates are higher in 4-level than 3-level ACDF.
Abstract
Cervical spine degenerative pathologies remain one of the most common spinal conditions
treated by spine surgeons worldwide. Surgery is recommended in all patients with symptomatic
cervical spinal stenosis with either moderate to severe myelopathy, degeneration,
or refractory radiculopathy. As the number of levels increases the potential for complications
associated with anterior surgery can be significant, especially dysphagia and pseudarthrosis.
The objective of this study was to analyze the fusion rate following three- or more
level anterior cervical discectomy and fusion (ACDF). A retrospective review was performed
analyzing patients who underwent three or more level ACDF. Fusion was evaluated using
post-operative dynamic upright radiographs Relevant post-operative complications especially
dysphagia requiring dietary modifications or placement of feeding tube was also noted.
A total of 72 patients were included in the study. Of the 232 levels fused, pseudarthrosis
occurred at 47 (14%) levels. Overall 45.8% of patients (33/72) had a pseudarthrosis.
The incidence of pseudarthrosis was higher in patients with 4 level ACDF as compared
to those with 3 level ACDF [56% (9/16) versus 42% (24/56)]. At last follow up, the
number of patients that were symptomatic from their pseudarthrosis and required posterior
spinal instrumentation was 8/72 (11.1%). Fusion rates in a large cohort of patients
with three- and four-level ACDF performed utilizing allograft and segmental instrumentation
is reported. The study demonstrates that 3–4 level, stand-alone anterior cervical
arthrodeses result in at least one level of pseudarthrosis in almost half of patients,
especially at the caudal level of the construct.
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Article info
Publication history
Published online: January 25, 2019
Accepted:
November 10,
2018
Received:
September 29,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
