Failure in Cervical Spinal Fusion and Current Management Modalities
| Autor: | Mervin Nunez, David S. Xu, Alexander E. Ropper, Michelle Kelly, Sebastian Winocour, Edward M. Reece, Terence Verla, Matthew J. Davis |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Modalities business.industry Arthrodesis medicine.medical_treatment medicine.disease Surgery 03 medical and health sciences Pseudarthrosis Plastic surgery 0302 clinical medicine Current management medicine 030212 general & internal medicine Neurosurgery Augment business 030217 neurology & neurosurgery Fixation (histology) |
| Zdroj: | Semin Plast Surg |
| ISSN: | 1535-2188 |
| Popis: | Failed fusion in the cervical spine is a multifactorial problem stemming from a combination of patient and surgical factors. Patient-related risk factors such as steroid use, poor bone quality, and smoking can be optimized preoperatively. Age, prior radiation, prior surgery, and underlying genetics are nonmodifiable patient-centered risk factors. Surgical risks for failed fusion include the number of segments fused, anterior versus posterior approach for fusion, the type of bone graft, and the instrumentation utilized. Many symptomatic cases of failed fusion (pseudarthrosis) result in pain, neurological deficits, or loosened hardware necessitating a revision surgery consisting of extending the prior construct and utilizing additional allografts or autografts to augment the fusion. Given the relatively mobile nature of the cervical spine, pseudoarthrosis (either known or anticipated) must be recognized by the spine surgeon, and steps should be considered to optimize the likelihood of future fusion. This consists of both performing a rigid fixation and using appropriate bone graft to enhance the environment for arthrodesis. Vascularized bone grafts are a useful tool to augment fusion and provide added structural stability in cases at high risk of pseudoarthrosis. |
| Databáze: | OpenAIRE |
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