Failure in Cervical Spinal Fusion and Current Management Modalities.

Area of Science:

• Orthopedic Surgery
• Spine Surgery
• Biomedical Engineering

Background:

• Failed fusion in the cervical spine, known as pseudarthrosis, is a complex issue with numerous contributing factors.
• Both patient-specific elements (e.g., steroid use, bone quality, smoking, age, genetics) and surgical choices (e.g., fusion length, approach, graft type, instrumentation) influence fusion outcomes.
• Symptomatic pseudarthrosis often leads to pain, neurological deficits, or hardware failure, frequently requiring revision surgery.

Purpose of the Study:

• To review the multifactorial causes of failed cervical spine fusion.
• To discuss strategies for optimizing fusion success and managing pseudarthrosis.
• To highlight the role of vascularized bone grafts in high-risk cases.

Main Methods:

• Literature review of patient and surgical factors impacting cervical spine fusion.
• Analysis of current surgical techniques and graft options for revision fusion.
• Discussion of risk factors and preventative measures for pseudarthrosis.

Main Results:

• Patient factors like steroid use, poor bone quality, smoking, age, and genetics contribute to fusion failure.
• Surgical factors including the number of fused segments, approach (anterior/posterior), graft type, and instrumentation are critical.
• Revision surgery often involves extending the construct and using allografts or autografts.

Conclusions:

• Recognizing and addressing modifiable patient risk factors preoperatively is essential.
• Rigid fixation and appropriate bone grafting techniques are crucial for successful cervical spine arthrodesis.
• Vascularized bone grafts offer enhanced fusion augmentation and structural support in challenging cases.