gms | German Medical Science

Objective: The operative treatment depending from the extension of degenerative cervical changes usually acquires an internal fixation in the sense of an instrumentation. The present study will to answer the following questions: 1. What is the overall revision rate following an operative treatment of degenerative cervical disorders using common operative techniques? 2. Is there any influence of the fusion length to the revision rate overall and especially to the decompensation ratio of adjacent segments? 3. What is the rate of revisions due to hardware failures? 4. Are there any differences concerning the revision rate between posterior and anterior instrumentation?

Methods: We reviewed 900 patients, who underwent a cervical spine surgery with an internal fixation at our institution between January 1994 and December 2000 (minimally follow up 2.2 years). Five different operative techniques were used: type I mono-and bisegmental intersomatic decompression and fusion using anterior instrumentation, type II multisegmental intersomatic decompression and fusion using anterior instrumentation, type III multisegmental anterior intersomatic decompression and fusion using posterior instrumentation, type IV one-level corpectomy with vertebral body replacement and anterior instrumentation and type V multi-level corpectomy with vertebral body replacement and posterior instrumentation. The revisions were analysed. The minimally follow up was 2.2 years (in mean 4,2 years).

Results: In total 121 revisions (13.4%) were recorded. The main indication for revision was hardware failure in 5.4%. Comparing the overall revision rate between the primary mono- and bisegmental operations with 77 out of 699 (11%) and the primary multisegmental operations 44 out of 157 (22%) a significant difference was found. Operations type I showes the lowest revision rate of 11%, type V operations the highest of 32%. Within this study 735 anterior instrumentations were performed responsible for 44 hardware related revision (6%). There were only 5 hardware related revisions (3%) among the 165 posterior instrumentation’s.

Conclusions: The revision rate overall was 13.4%. There were no any relation between fusion length an adjacent segment problems. Revisions due to hardware problems constituted 40 % of the whole revision rate. Posterior instrumentations show a significant lower rate of hardware failure compared to anterior instrumentations. The revision rate of multilevel corpectomies is unacceptable high.