Presented at the 2013 AAPM Annual Meeting « Back

Structural Causes of Failed Anterior Cervical Decompression and Fusion

Jerome Schofferman, MD, jschofferman@spinecare.com¹, (1) SpineCare Medical Group, Daly City, California

Introduction: Pain physicians treat patients with persistent or recurrent neck pain (NP) after anterior cervical discectomy and fusion (ACDF). We presume the best outcomes occur when treatment is specific for the underlying structural cause. Therefore it is important to know the most common causes of "failed ACDF". Methods: This study was IRB approved. We prospectively evaluated consecutive patients with NP after ACDF using history, examination, x-rays with flexion and extension views, MRI or CT, and appropriate diagnostic injections. We used established criteria for diagnosis of facet joint pain, disc-mediated pain and pseudarthrosis. Results: There were 14 women and 10 men. Average age was 49. After surgery nine patients never improved or developed pain at ≤6 weeks, six at 6 weeks to 6 months, and nine had recurrence of pain ≥6 months. Fourteen patients had one diagnosis only: disc-mediated pain at adjacent segment in 7, facet joint pain in 5, and pseudarthrosis in 2. Nine patients had two diagnoses: disc plus facet-mediated pain in 5; pseudarthosis plus facet joint pain in 4. In the twelve with disc-mediated pain at adjacent segment, six had these abnormal segments prior to but not addressed at surgery. Conclusion: Using the history, imaging studies, and diagnostic injections we were able to establish the structural cause of failed ACDF. 39% had more than one diagnosis. The most common diagnoses, alone or combined, were facet joint pain (61%), disc-mediated pain (52%) and pseudarthrosis (26%). This information has not been reported previously. References: 1) Lee M, Dettori J, Standaert C, Chapman J. Indication for spinal fusion and the risk of adjacent segment pathology: does reason for fusion affect risk? A systematic review. Spine 2012. in press. 2) Ghiselli G, Wharton N, Hipp J et al. Prospective analysis of imaging prediction of pseudarthorosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation. Spine 2011;3. 3) Manchikanti L, Manchikanti K, Pampati V, Brandon DE, Giordano J. The prevalence of facet-joint-related chronic neck pain in postsurgical and nonpostsurgical patients: a comparative evaluation. Pain Pract. 2008;8:5-10. 4) Matsumoto M, Okada E, Ichihara D, Watanabe K, et al. Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine 2010;35:36- 5) Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011 Dec;4(4):168-74.

Funding: CDC R21

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