Management of Symptomatic Cervical Spine Pseudarthrosis: A Suggested Algorithm for Surgical Planning

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Figure 1
(A) Plain x-ray, (B) preoperative computed tomography, and (C) preoperative magnetic resonance imaging of a 52-year-old male patient presenting with symptomatic pseudarthrosis C4/5 18 months after anterior cervical decompression and fusion (ACDF). The preoperative workup showed an additional adjacent segment disease, C5-7. He was treated by anterior revision and ACDF C5-7 and achieved solid arthrodesis at the final follow-up (D).
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Figure 2
(A) Plain x-ray and (B) preoperative computed tomography of a 45-year-old female patient presenting with symptomatic pseudarthrosis C4/5 and C6/7 3 years after anterior cervical decompression and fusion. She was treated by posterior fusion and achieved solid arthrodesis 2 years postoperatively (C).
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Figure 3
Treatment plan for symptomatic pseudarthrosis after anterior cervical decompression and fusion (ACDF). ASD, adjacent segment disease.

Table 1

Summary of the clinical and surgical data during the study period (N = 95).

Patients With Symptomatic Pseudarthrosis	Anterior-Only Group (n = 62)	Posterior-Only Group (n = 13)	Combined Anterior and Posterior (n = 20)
Blood loss	208 ± 150 mL	710 ± 560 mL	1070 ± 850 mL
Operation time	130 ± 60 min	123 ± 68 min	193 ± 74 min
Mean lordosis correction	8.75 ± 5.4 to 12.6 ± 4.4°	10.4 ± 2.3 to 11.7 ± 3.2°	8.4 ± 2.3 to 16.6 ± 3.2°
Revision	No revisions	No revisions	- One retropharyngeal hematoma - Three cage sinking with kyphosis
VAS improvement, preoperative to final follow-up	From 7.5 ± 2 to 2.3 ±1.7 (P = 0.001)
NDI Improvement, preoperative to final follow-up	From 26.4 ± 5 to 8.7 ±3.2 (P = 0.034)
Graft site pain	5 patients (5.2%)
Dysphagia	3 patients (3.3%)
Follow-up period	52 ± 28 mo (minimum 24 and maximum 120 mo)
Time until fusion	7.8 ± 2.9 mo (between 6 and 12 mo)

Table 2

The number of studied patients and the mean follow-up in literature dealing with cervical spine pseudarthrosis.