Posterior Cervical Fusion Using Cervical Interfacet Spacers in Patients With Symptomatic Cervical Pseudarthrosis

摘要

BACKGROUND:Posterior cervical fusion with cervical interfacet spacer (CIS) is a novel allograft technology offering the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion by placing the allograft in compression.OBJECTIVE:To analyze the clinical and radiological outcomes after posterior cervical fusion with CIS in patients with symptomatic anterior cervical pseudarthroses.METHODS:Medical records of patients who underwent posterior cervical fusion with CIS for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion were reviewed. Standardized outcome measures such as visual analog scale (VAS) score for neck and arm pain, Neck Disability Index (NDI), and upright lateral cervical radiographs were reviewed.RESULTS:There were 19 patients with symptomatic cervical pseudarthrosis. Preoperative symptoms included refractory neck or arm pain. The average follow-up was 20 months (range, 12-56 months). There was improvement in VAS score for neck pain (P < .004), radicular arm pain (P < .007), and NDI score (P < .06) after surgery, with 83%, 72%, and 67% of patients showing improvement in their VAS neck pain, VAS arm pain, and NDI scores, respectively. Fusion rate was high, with fusion occurring at all levels treated for pseudarthrosis. There was a small improvement in cervical lordosis (mean difference, 2 5.17 degrees; P = .09) and slight worsening of C2-7 sagittal vertical axis after surgery (mean difference, 1.89 7.87 mm; P = .43).CONCLUSION:CIS provides an important fusion technique, allowing placement of an allograft in compression for posterior cervical fusion in patients with anterior cervical pseudarthroses. Although there was improvement in clinical outcome measures after surgery, placement of CIS had no clinically significant impact on cervical lordosis and C2-7 sagittal vertical axis.ABBREVIATIONS:ACDF, anterior cervical diskectomy and fusionCIS, cervical interfacet spacerICBG, iliac crest bone graftNDI, Neck Disability IndexSVA, sagittal vertical axisVAS, visual analog scale