The Efficacy of Anterior Cervical Plating in the Management of Symptomatic Pseudoarthrosis of the Cervical Spine

STUDY DESIGN: A retrospective review of 16 consecutive patients treated with anterior resection of the pseudoarthrosis, autogenous iliac crest bone grafting, and stabilization with an anterior cervical plate. OBJECTIVES: To determine the efficacy of anterior cervical plating used to manage symptomatic pseudoarthrosis of the cervical spine and obtain safe radiographic fusion and improved clinical results. SUMMARY OF BACKGROUND DATA: It is generally recognized that the clinical outcome of anterior cervical discectomy and fusion correlates with rates of fusion. There is debate in the literature as to how the patient with symptomatic cervical pseudoarthrosis should be addressed. Recent reports would support a posterior approach rather than a revision anterior approach. METHODS: Sixteen consecutive patients with symptomatic pseudoarthrosis of the cervical spine were treated with anterior resection of the pseudoarthrosis, autogenous iliac crest bone grafting, and stabilization with an anterior cervical plate. The average follow-up period was 51 months, and patients were assessed using physical examinations, questionnaires, and flexion-extension lateral radiographs. RESULTS: In all, 75% of the patients reported improvement of their symptoms, and 69% of patients returned to work. Fusions were graded I or II in 81% of the patients. No patient demonstrated radiographic instability, and none required revision surgery. Involvement with workers' compensation litigation negatively affected the clinical outcome. CONCLUSIONS: Patients in whom symptomatic cervical pseudoarthrosis develops after cervical anterior discectomy and fusion may be managed successfully with anterior resection of the pseudoarthrosis, autogenous bone grafting, and an anterior cervical plate. Successful clinical results regarding return to work status and general satisfaction with the surgical procedure depend not only on obtaining a successful radiographic fusion, but also on patient selection.