Management of anterior cervical pseudarthrosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome

“…In the event of the development of pseudarthrosis, Kaiser et al 8 report that the current evidence weakly supports (Class III) surgical correction of pseudarthrosis by either anterior and posterior approaches, with a higher rate of fusion seen in the latter group but no definite difference in outcome. Finally, the use of arthroplasty in the management of cervical degenerative disc disease continues to evoke controversy.…”

Anterior Cervical Pseudarthrosis

“…3,30 This approach may also be more effective in treating kyphotic deformity and primary ventral pathology compressing the nerve or spinal cord (Figure 3). When symptomatic pseudarthrosis requires a revision, proponents of the anterior revision approach cite decreased blood loss, shorter hospital stay, and avoidance of posterior muscle dissection as reasons to use the anterior approach.…”

“…Up to 33% of patients with pseudarthrosis can remain asymptomatic 5 years after surgery. 3 The posterior approach also provides normal anatomy and host bone for internal fixation and fusion formation. 4,5,30,[34][35][36][37] The major benefit of the posterior approach includes avoidance of anterior scar tissue, which can compromise natural tissue planes.…”

Posterior Cervical Lateral Mass Screw Fixation and Fusion to Treat Pseudarthrosis of Anterior Cervical Fusion

“…[6][7][8][9] To date, there is still debate in the literature as how the patient with symptomatic cervical pseudarthrosis should be addressed. 10 In this study, we report 38 patients treated by posterior lateral mass screw/rod fixation with posterior fusion and followed up for at least 24 months after surgery.…”