An outcomes analysis of the treatment of cervical pseudarthrosis with posterior fusion

A retrospective review of 33 consecutive patients treated with posterior fusion and selective nerve root decompression for the treatment of pseudarthrosis following anterior cervical discectomy and fusion. Use standardized outcome measures to evaluate the results of posterior fusion with selective nerve root decompression as a treatment option for symptomatic pseudarthrosis of the cervical spine. Pseudarthrosis after anterior cervical discectomy and fusion has been recognized as a cause of continued cervical pain and unsatisfactory outcomes. Debate continues as to whether a revision anterior approach or a posterior fusion procedure is the best treatment for symptomatic cervical pseudarthrosis. To our knowledge, standardized outcome measures have not been used to evaluate the results of either surgical treatment option; therefore, it is difficult to evaluate outcomes in these patients, let alone compare surgical treatment options. Data on fusion rates in these two surgical treatment groups suggest a trend of a higher fusion rate with utilization of a posterior revision procedure, but the largest study to date includes the study of only 19 patients treated with a posterior fusion. Thirty-three consecutive patients with symptomatic pseudarthrosis following anterior cervical discectomy and fusion were treated with selective nerve root decompression and posterior fusion using iliac crest or local bone graft as well as posterior wiring and/or lateral mass plating. The average follow-up period was 46 months (range, 20-86 months). Patients were assessed using physical examination, flexion-extension lateral radiographs, and standardized outcome measures including the SF-36, Arthritis Impact Measurement Scales 2, and Cervical Spine Outcomes Questionnaire. All 33 patients (100%) demonstrated a solid fusion at their most recent follow-up, and all 33 patients noted significant improvement in their preoperative symptoms. No difference in fusion status was noted between those treated with iliac crest versus patients treated with local bone graft--all had a solid fusion; 72% of the patients were satisfied with the result of their surgery. Cervical Spine Outcomes Questionnaire pain scales demonstrated 52% of patients reported mild or nopain at follow-up, whereas 20% described their pain as "discomforting" and 28% of the patients continued to report moderate to severe pain. This is the first study to our knowledge to use standardized outcome measures to assess clinical outc