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

The involvement of infectious agents has been demonstrated in some cases of lumbar pseudarthrosis, but remains poorly documented and discussed for anterior cervical discectomy and fusion (ACDF) pseudarthrosis. The purpose of our work was to determine whether an infectious source should be suspected in cervical pseudarthrosis following ACDF.

Between August 2018 and August 2023, 45 patients with previous ACDF underwent surgical revision for pseudarthrosis.

The median age at initial ACDF surgery was 46 years (standard deviation [SD] 9.4). The mean time to clinical reoccurrence or worsening after the initial surgery was 13 months (SD 15.9). The mean time to pseudarthrosis confirmation by imaging was 25 months (SD 25.1). Pseudarthrosis was diagnosed directly by a CT scan positive non-fusion for 31/45 patients (68.9%) and by the addition of a positive ¹⁸positron emission tomography with sodium fluoride/computed tomography for the remaining 14/45 patients (31.1%). The mean time from initial surgery to pseudarthrosis revision was 32.16 months (SD 25.4). During revision surgery, 29/45 patients (64.4%) had a bacterial culture taken, which revealed a microorganism. Among these 29 patients, 2 patients, for whom no initial cultures were taken during the pseudarthrosis revision, required a second surgery for recurrent-pseudarthrosis with positive bacterial cultures. However, patients in the pseudarthrosis with infection group had a significantly lower mean score percentage improvement in Neck Disability Index than the others (26% vs. 59.3%, P = 0.01).

In cervical pseudarthrosis, an infection should be considered as a potential cause. Surgical revision must include bacteriological sampling and antibiotic prophylaxis. Patients reoperated for infectious pseudarthrosis often suffered from residual neck pain.