Pseudarthrosis After Anterior Cervical Discectomy and Fusion: An Infectious Source Might be Suspected

Area of Science:

• Spine Surgery
• Infectious Disease
• Orthopedics

Background:

• Infectious agents are implicated in lumbar pseudarthrosis but poorly understood in anterior cervical discectomy and fusion (ACDF) pseudarthrosis.
• This study investigates the role of infection in cervical pseudarthrosis following ACDF.

Purpose of the Study:

• To determine if an infectious source should be suspected in cervical pseudarthrosis after ACDF.
• To evaluate the impact of infection on outcomes following ACDF pseudarthrosis revision surgery.

Main Methods:

• Retrospective analysis of 45 patients undergoing revision surgery for ACDF pseudarthrosis between August 2018 and August 2023.
• Diagnosis of pseudarthrosis confirmed by CT scan and/or 18F-NaF PET/CT.
• Bacterial cultures obtained during revision surgery for 29/45 patients.

Main Results:

• A microorganism was identified in bacterial cultures from 64.4% of patients undergoing revision surgery.
• Patients with infectious pseudarthrosis had significantly lower improvement in Neck Disability Index (NDI) scores (26% vs. 59.3%, p=0.01).
• Two patients required reoperation for recurrent pseudarthrosis due to positive bacterial cultures.

Conclusions:

• Infection should be considered a potential cause of cervical pseudarthrosis.
• Surgical revision for ACDF pseudarthrosis necessitates bacteriological sampling and antibiotic prophylaxis.
• Patients with infectious pseudarthrosis often experience persistent neck pain.