Revision Surgery for Failed Cervical Spine Reconstruction

Abstract

Background: As the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Surgeons need to understand the etiology of post-surgical changes, as well as have a treatment algorithm when evaluating these complex patients. Questions/Purposes: This study aims to review the rates and etiology of revision cervical spine surgery as well as describe our treatment algorithm. Methods: We used a narrative and literature review. We performed a MEDLINE (PubMed) search for "cervical" and "spine" and "revision" which returned 353 articles from 1993 through January 22, 2014. Abstracts were analyzed for relevance and 32 articles were reviewed. Results: The rates of revision surgery on the cervical spine vary by the type and extent of procedure performed. Patient evaluation should include a detailed history and review of the indication for the index procedure, as well as lab work to rule out infection. Imaging studies including flexion/extension radiographs and computed tomography are obtained to evaluate potential pseudarthrosis. Magnetic resonance imaging is helpful to evaluate the disc, neural elements, soft tissue, and to differentiate scar from infection. Sagittal alignment should be corrected if necessary. Conclusions: Recurrent or new symptoms after cervical spine reconstruction can be effectively treated with revision surgery after identifying the etiology, and completing the appropriate workup.

Cervical sagittal alignment after different anterior discectomy procedures for single-level cervical degenerative disc disease: randomized controlled trial

“…Due to the kind of procedure, we did not assume that a clinically significant translation within the cervical spine would occur since posterior elements remained untouched and the disruption of the anterior part was minimal. Otherwise, measurement of the C2–C7 SVA would be more appropriate [ 20 , 22 ].…”

Three-Column Osteotomy for the Treatment of Rigid Cervical Deformity

“…If a grade 7 osteotomy is the goal in severely kyphotic patients, a posterior-anteriorposterior approach may be warranted; however, this has been associated with high morbidity and complication rates. 13,15,34 In rare case, an anterior approach may not be possible and posterior based only approaches such as grade 5 and 6 osteotomies are the only options.…”

A Novel Local Cancellous Autograft Source for Anterior Cervical Discectomy With Fusion

“…Revision surgery for pseudarthrosis often involves a posterior approach that typically produces higher incidences of pain after surgery and can lead to increased hospital length of stay. 8,9 Considering the improved outcomes seen with the addition of fusion, this has become the standard of care in treatment of cases of cervical radiculopathy and myelopathy. 10 There are many different sources of graft material including autograft, allograft, and varied synthetic osteoconductive scaffolds.…”