Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis.

Farey, Ian D.; McAfee, Paul C.; Davis, Randy F.; Long, Donlin M.

doi:10.2106/00004623-199072080-00007

Cited by 114 publications

(48 citation statements)

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“…Farey et al 9 described the outcome in 19 patients treated for symptomatic anterior nonunion with posterior decompression, wire stabilization, and fusion. The authors reported circumferential fusion in 100%, with 95% demonstrating clinical improvement.…”

Section: Evidence Supporting the Posterior Approachmentioning

confidence: 99%

Management of anterior cervical pseudarthrosis

Kaiser

Mummaneni

Matz

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

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Section: Evidence Supporting the Posterior Approachmentioning

confidence: 99%

Management of anterior cervical pseudarthrosis

Kaiser

Mummaneni

Matz

et al. 2009

SPI

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“…Although non-fusion is not typically associated with poor clinical outcomes, its significant role in postoperative morbidity is well documented [4,5,10,14,23].…”

Section: Petr Suchomel Pavel Barsa Pavel Buchvald Adam Svobodnik Eva mentioning

confidence: 99%

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

et al. 2004

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IntroductionAnterior cervical discectomy and fusion (ACDF) in the subaxial cervical spine as originally suggested by Badgley in 1939 and described by Robinson and Smith in 1955 [28] and Cloward in 1958 [8] has established itself as a method of treatment for patients with neural compression by disc material or osteophytes.Although the interbody location of applied bone graft is a favourable healing environment, because of the relatively large surface area of subchondral cancellous bone Abstract Background. The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature. Methods. Seventy-nine consecutive patients were operated on using the Smith-Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years. Results.The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one-and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions.This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and nonsmokers in the rate or course of fusion as previously reported.

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“…В настоящее время боль-шинство хирургов предпочитает выполнение переднего доступа. Тревожным является тот факт, что при выполне-нии спондилодеза на двух и более уровнях увеличивается риск возникновения псевдоартроза, то есть несостоятель-ности конструкции [8]. Другими осложнениями переднего доступа являются переломы и смещение системы имплан-тации (винтов, пластин, аллотрансплантата) и осложнения, связанные с доступом, в числе которых дисфагия, дисфунк-ция возвратного гортанного нерва, повреждение пищевода, сонной артерии.…”

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Laminoplasty in Surgical Treatment of Cervical Spondylotic Myelopathy: Literature Review

Древаль¹,

Гуща²

2015

Hir. pozvonoč.

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Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis.

Cited by 114 publications

References 0 publications

Management of anterior cervical pseudarthrosis

Management of anterior cervical pseudarthrosis

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

Laminoplasty in Surgical Treatment of Cervical Spondylotic Myelopathy: Literature Review

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