• World Neurosurg · Nov 2022

    Incidence of Pseudarthrosis and Subsequent Surgery After Cervical Fusion Surgery: A Retrospective Review of a National Healthcare Claims Database.

    • Glenn A Gonzalez, Katherine Corso, Sidharth Kr, Guilherme Porto, John Wainwright, Daniel Franco, Jingya Miao, Kevin Hines, Matthew O'Leary, Nikolaos Mouchtouris, Aria Mahtabfar, Nathaniel Neavling, Thiago S Montenegro, Sara Thalheimer, Ashwini Sharan, Jack Jallo, and James Harrop.
    • Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: glennarturo.gonzalezozuna@jefferson.edu.
    • World Neurosurg. 2022 Nov 1; 167: e806e845e806-e845.

    BackgroundCervical pseudarthrosis is a postoperative adverse event that occurs when a surgically induced fusion fails to establish bone growth connecting the 2 regions. It has both clinical and financial implications and may result in significant patient morbidity; it continues to be one of the leading causes of pain after surgery.MethodsA retrospective longitudinal cohort study was performed. Patients in the IBM MarketScan Commercial Claims and Encounters (CCAE) database, 18-64 years old, who underwent elective cervical fusions during 2015-2019 were included. Patients with trauma, infection, or neoplasm were excluded. Patients were followed for 2 years from surgical fusion for occurrence of pseudarthrosis. After pseudarthrosis, subsequent surgery was documented, and cumulative incidence curves, adjusted for patient/procedure characteristics, with 95% confidence intervals (CIs) were generated. Risk factors were evaluated with multivariable Cox regression analysis.ResultsThe cohort included 45,584 patients. The 1-year and 2-year incidence of pseudarthrosis was 2.0% (95% CI, 1.9%-2.2%) and 3.3% (95% CI, 3.1%-3.5%), respectively. Factors significantly associated with increased risk of pseudarthrosis were female gender, current/previous substance abuse, previous spinal pain in the cervical/thoracic/lumbar spine, and Elixhauser score ≥5. Factors significantly associated with decreased risk of pseudarthrosis were anterior cervical approach, use of an interbody cage, and 2-level or 3-level anterior instrumentation. The 1-year and 2-year incidence of subsequent surgery in patients with pseudarthrosis was 11.7% (95% CI, 9.6%-13.7%) and 13.8% (95% CI, 11.5%-16.2%), respectively.ConclusionsCervical pseudarthrosis and subsequent surgery still occur at a low rate. Surgical factors such as anterior approach, interbody cage use, and anterior instrumentation may reduce pseudarthrosis risk.Copyright © 2022 Elsevier Inc. All rights reserved.

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