Revision Surgery for Failed Cervical Spine Reconstruction

Review Article

Abstract

Background

As the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Surgeons need to understand the etiology of post-surgical changes, as well as have a treatment algorithm when evaluating these complex patients.

Questions/Purposes

This study aims to review the rates and etiology of revision cervical spine surgery as well as describe our treatment algorithm.

Methods

We used a narrative and literature review. We performed a MEDLINE (PubMed) search for “cervical” and “spine” and “revision” which returned 353 articles from 1993 through January 22, 2014. Abstracts were analyzed for relevance and 32 articles were reviewed.

Results

The rates of revision surgery on the cervical spine vary by the type and extent of procedure performed. Patient evaluation should include a detailed history and review of the indication for the index procedure, as well as lab work to rule out infection. Imaging studies including flexion/extension radiographs and computed tomography are obtained to evaluate potential pseudarthrosis. Magnetic resonance imaging is helpful to evaluate the disc, neural elements, soft tissue, and to differentiate scar from infection. Sagittal alignment should be corrected if necessary.

Conclusions

Recurrent or new symptoms after cervical spine reconstruction can be effectively treated with revision surgery after identifying the etiology, and completing the appropriate workup.

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Disclosure

Conflict of Interest:

John D. Koerner, MD, and Christopher K. Kepler, MD, MBA, have declared that they have no conflict of interest. Todd J. Albert, MD, receives royalties from Depuy and Biomet Spine; receives consultant fees from Depuy and Facetlink; stock option or stocks from K2M, Vertech, In Vivo Therapeutics, Paradigm Spine, Pearldriver, Biomerix, Breakaway Imaging, Crosstree, Invuity, Pioneer, Gentis, ASIP, PMIG, and Spinicity, outside the work.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Correspondence to Todd J. Albert MD.

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This work was performed at the Rothman Institute, Thomas Jefferson University and Hospital, Philadelphia, PA

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Koerner, J.D., Kepler, C.K. & Albert, T.J. Revision Surgery for Failed Cervical Spine Reconstruction. HSS Jrnl 11, 2–8 (2015). https://doi.org/10.1007/s11420-014-9394-8

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Keywords

  • cervical
  • revision
  • pseudarthrosis
  • adjacent segment