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Revision surgery in cervical spine

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Abstract

Purpose

To report the indications, presurgical planning, operative techniques, complications for making decisions in cervical revision surgery (CRS).

Methods

Hundred and two patients underwent CRS over a four-year period. Epidemiological data, the type of first surgery, CRS surgical techniques and complications were retrospectively evaluated. Pain and neurological symptoms were assessed according to the validated Odom criteria. CRS indications were classified into five categories: adjacent segment disease (ASD), infection (INF), implant failure–pseudarthrosis (IFP), non-infectious complication, and deformity. Patients were classified into three groups, according to the approach of the index procedure: anterior, posterior, or 360°.

Results

The mean patient age was 63 years (59% males). ASD (40%), INF (23%), and IFP (22%) were observed in 85% of patients. CRS was performed with the same approach that was used in the index procedure in 64% of the anterior group and in 83% of the posterior group. In the 360° group, 64% of CRSs was performed with a posterior access. The early complication rate was 4.9%. The outcome was excellent in 19 patients (19%), good in 37 patients (36%), satisfactory in 27 patients (26%), and poor in six patients (6%). Thirteen patients (13%) were lost to follow-up. No implants failed radiologically or required surgical revision.

Conclusions

CRS required painstaking planning and mastery of a variety of surgical techniques. The results were rewarding in half and satisfactory in a quarter of the patients. The complication rate was lower than expected. In the most complex cases, referral to a specialized center is recommended.

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Authors and Affiliations

  1. Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany

    Luca Papavero & Gregor Schmeiser

  2. GSpine4, I.R.C.C.S, Istituto Ortopedico Galeazzi, Milan, Italy

    Paolo Lepori

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  1. Luca Papavero
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  2. Paolo Lepori
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Correspondence to Luca Papavero.

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All procedures were performed in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Papavero, L., Lepori, P. & Schmeiser, G. Revision surgery in cervical spine. Eur Spine J 29 (Suppl 1), 47–56 (2020). https://doi.org/10.1007/s00586-019-06281-x

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  • DOI: https://doi.org/10.1007/s00586-019-06281-x

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