PMID- 37644445
OWN - NLM
STAT- MEDLINE
DCOM- 20230831
LR  - 20231121
IS  - 1471-2474 (Electronic)
IS  - 1471-2474 (Linking)
VI  - 24
IP  - 1
DP  - 2023 Aug 29
TI  - Pseudoarthrosis after anterior cervical discectomy and fusion: rate of occult 
      infections and outcome of anterior revision surgery.
PG  - 688
LID - 10.1186/s12891-023-06819-7 [doi]
LID - 688
AB  - BACKGROUND: Pseudoarthrosis after anterior cervical discectomy and fusion (ACDF) 
      is relatively common and can result in revision surgery. The aim of the study was 
      to analyze the outcome of patients who underwent anterior revision surgery for 
      pseudoarthrosis after ACDF. METHODS: From 99 patients with cervical revision 
      surgery, ten patients (median age: 48, range 37-74; female: 5, male: 5) who 
      underwent anterior revision surgery for pseudoarthrosis after ACDF with a minimal 
      follow up of one year were included in the study. Microbiological investigations 
      were performed in all patients. Computed tomography (CT) scans were used to 
      evaluate the radiological success of revision surgery one year postoperatively. 
      Clinical outcome was quantified with the Neck Disability Index (NDI), the Visual 
      Analog Scale (VAS) for neck and arm pain, and the North American Spine Society 
      Patient Satisfaction Scale (NASS) 12 months (12-60) after index ACDF surgery. The 
      achievement of the minimum clinically important difference (MCID) one year 
      postoperatively was documented. RESULTS: Occult infection was present in 40% of 
      patients. Fusion was achieved in 80%. The median NDI was the same one year 
      postoperatively as preoperatively (median 23.5 (range 5-41) versus 23.5 (7-40)), 
      respectively. The MCID for the NDI was achieved 30%. VAS-neck pain was reduced by 
      a median of 1.5 points one year postoperatively from 8 (3-8) to 6.5 (1-8); the 
      MCID for VAS-neck pain was achieved in only 10%. Median VAS-arm pain increased 
      slightly to 3.5 (0-8) one year postoperatively compared with the preoperative 
      value of 1 (0-6); the MCID for VAS-arm pain was achieved in 14%. The NASS patient 
      satisfaction scale could identify 20% of responders, all other patients failed to 
      reach the expected benefit from anterior ACDF revision surgery. 60% of patients 
      would undergo the revision surgery again in retrospect. CONCLUSION: Occult 
      infections occur in 40% of patients who undergo anterior revision surgery for 
      ACDF pseudoarthrosis. Albeit in a small cohort of patients, this study shows that 
      anterior revision surgery may not result in relevant clinical improvements for 
      patients, despite achieving fusion in 80% of cases. LEVEL OF EVIDENCE: 
      Retrospective study, level III.
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Calek, Anna-Katharina
AU  - Calek AK
AD  - Department of Orthopedics, Balgrist University Hospital, University of Zurich, 
      Forchstrasse 340, Zurich, CH-8008, Switzerland. anna-katharina.calek@balgrist.ch.
FAU - Winkler, Elin
AU  - Winkler E
AD  - Department of Orthopedics, Balgrist University Hospital, University of Zurich, 
      Forchstrasse 340, Zurich, CH-8008, Switzerland.
FAU - Farshad, Mazda
AU  - Farshad M
AD  - Department of Orthopedics, Balgrist University Hospital, University of Zurich, 
      Forchstrasse 340, Zurich, CH-8008, Switzerland.
AD  - Balgrist University Hospital, University Spine Center Zurich, University of 
      Zurich, Zurich, Switzerland.
FAU - Spirig, Jose Miguel
AU  - Spirig JM
AD  - Balgrist University Hospital, University Spine Center Zurich, University of 
      Zurich, Zurich, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20230829
PL  - England
TA  - BMC Musculoskelet Disord
JT  - BMC musculoskeletal disorders
JID - 100968565
SB  - IM
MH  - Humans
MH  - Female
MH  - Male
MH  - Middle Aged
MH  - Reoperation
MH  - *Neck Pain/etiology/surgery
MH  - *Pseudarthrosis/diagnostic imaging/etiology/surgery
MH  - Retrospective Studies
MH  - Diskectomy/adverse effects
PMC - PMC10464399
OTO - NOTNLM
OT  - ACDF
OT  - Anterior cervical discectomy and fusion
OT  - Cervical spine
OT  - Pseudoarthrosis
OT  - Revision surgery
COIS- The authors report no conflicts of interest.
EDAT- 2023/08/30 00:41
MHDA- 2023/08/31 06:42
PMCR- 2023/08/29
CRDT- 2023/08/29 23:46
PHST- 2023/01/02 00:00 [received]
PHST- 2023/08/22 00:00 [accepted]
PHST- 2023/08/31 06:42 [medline]
PHST- 2023/08/30 00:41 [pubmed]
PHST- 2023/08/29 23:46 [entrez]
PHST- 2023/08/29 00:00 [pmc-release]
AID - 10.1186/s12891-023-06819-7 [pii]
AID - 6819 [pii]
AID - 10.1186/s12891-023-06819-7 [doi]
PST - epublish
SO  - BMC Musculoskelet Disord. 2023 Aug 29;24(1):688. doi: 10.1186/s12891-023-06819-7.