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

Abstract

Patients with symptomatic cervical pseudarthrosis that develops after anterior cervical discectomy and fusion may be managed successfully with posterior lateral mass screw fixation and fusion.

Lateral Mass Screw Fixation in the Cervical Spine

“…Mean ages ranged from 32.4 to 68 years across the studies (with individual patient ages ranging from sixteen to eighty-four years); the younger patients were primarily in the trauma studies. With the exception of one study in which only 23.7% of the patients were male 19 , the majority of patients across all studies were male (range of percentages, 50% to 84.1%). Mean follow-up durations ranged from nine to 47.5 months.…”

“…Outcomes for a total of 1257 patients were reviewed in the eighteen case series evaluating subaxial posterior cervical fusion utilizing lateral mass screws. Of the studies, eight involved patients with spondylosis (n = 555) 9, [13][14][15][16][17][18][19] , two involved patients with trauma (n = 73) 2,20 , and eight involved patients with mixed diagnoses (n = 629) 5,7,8,[21][22][23][24][25] . Two of the case series were actually arms of studies comparing lateral mass screw fixation with a comparator that did not meet our inclusion criteria (i.e., anterior corpectomy and open-door laminoplasty); the results were reported in such a way as to allow us to treat the lateral mass screw group as a case series 13,15 .…”

“…Local Safety in the Case Series (See Appendix) Overall, local safety complications were low as reported in fifteen studies. The greatest risk was seen for superficial infection (2.9%; 95% CI, 1.9% to 3.9%) in fourteen studies (n = 1111) 2,5,7,9,13,14,16,17,19,20,[22][23][24][25] , followed by hematoma and/or seroma (1.0%; 95% CI, 0.3% to 1.7%) in six studies (n = 704) 5,7,9,14,18,24 , evacuation surgery for hematoma (0.9%; 95% CI, 0% to 1.7%) in four studies (n = 454) 5,7,14,24 , dysphagia (0.6%; 95% CI, 0% to 1.9%) in one small study (n = 158) 14 , and deep infection (0.6%; 95% CI, 0.1% to 1.2%) in seven studies (n = 680) 5,7,9,13,20,23,25 .…”

“…In the second study, 9.1% of patients in the lateral mass screw group (n = 22) compared with 16.7% in the control group (n = 24) had neck pain affecting activities of daily living at one year 11 . *For assessment of fusion, four studies 8,9,19,23 used radiography and CT and five studies 2,17,21,24,25 used radiography only. Fusion criteria (when reported) varied slightly across the studies and consisted primarily of evidence of stability on dynamic radiographs, bone trabeculation across facet joints or disc spaces, and absence of radiolucency on CT. †Probable small overlap of populations in the 2004 and 2011 studies by Katonis et al 8,9 .…”

Revision Surgery for Failed Cervical Spine Reconstruction

“…In patients with anterior cervical pseudarthrosis, either an anterior revision procedure [50], or a posterior fusion procedure can lead to good results [25,27]. A combined anterior/posterior procedure may be necessary to achieve stability in some cases.…”