An analysis of failures in primary cervical anterior spinal cord decompression and fusion

Recently, postoperative results of cervical spondylosis, disc herniation, and ossification of the posterior longitudinal ligament (OPLL) after anterior cervical surgeries have improved. However, occasional unsatisfactory cases needing a second operation remain. We analyzed and developed strategies for multioperated neck (MON) cases; all patients had two operations. From 1965 to 1988, 443 cervical anterior surgeries were performed in our hospitals; 53 (12.0%) of these patients needed second operations. These MON cases were classified by the following causes: pseudarthrosis, graft fracture, insufficient decompression, misdiagnosis, and adjacent disc problems. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described.