Fusion rates following Posterior Cervical Laminectomy and Fusion Surgery: A Systematic Literature Review

Presented at SMISS Annual Forum 2014
By Islam Elboghdady
With Kern Singh MD, Branko Skovrlj MD, Sheeraz Qureshi MD, MBA, Alejandro Marquez-Lara MD, Khaled Aboushaala MD, Junyoung Ahn , Spencer Leblang , Motasem Al Maaieh MD,

Disclosures: Islam Elboghdady None Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th, Branko Skovrlj MD None, Sheeraz Qureshi MD, MBA A; Cervical Spine Research Society. B; Zimmer-Biomet, Stryker Spiner, Globus Medical, Inc. D; Avaz Surgical. F; RTI, Zimmer-Biomet, Stryker Spine, Alejandro Marquez-Lara MD None, Khaled Aboushaala MD None, Junyoung Ahn None, Spencer Leblang None, Motasem Al Maaieh MD None,

Introduction:
Posterior cervical laminectomy and fusion “PCLF” is a frequently performed procedure to address multilevel cervical spinal pathology.

Aims/Objectives:
The purpose of this study was to perform a comprehensive systematic review of the literature and to analyze published manuscripts that assess the fusion rates after PCLF in patients with multi-level degenerative disease of the sub-axial cervical spine.

Methods:
A systematic search was performed in Medline and Pubmed-National Library of Medicine/National Institutes of Health (http://www.ncbi.nlm.nih.gov) for articles published between 1959 and February 1, 2014. Keywords included: “Posterior cervical laminectomy and fusion”, “Pseudarthrosis after posterior cervical laminectomy and fusion”, “Fusion rates after posterior cervical laminectomy and fusion”, and “Nonunion after posterior cervical laminectomy and fusion”. Articles that did not clearly define the surgical indication or that reported fusion rates for treatment of anterior pseudoarthrosis, trauma, tumor and infection in the cervical spine were excluded. Only articles that were written in English and reported fusion rates after posterior laminectomy and lateral mass/pedicle screw and rod fixation for the management of degenerative sub-axial cervical spine pathologies were included in the analysis.

Results:
Our initial search yielded a total of 412 articles. Thirty-six articles were selected on the basis of title relevance for abstract/full text review. Only five articles met inclusion criteria (Table 1). All of the articles were retrospective in nature and reported fusion rates that varied between 62% -100%. Only one of the reviewed articles investigated fusion rates as the primary outcome of the study. Fusion assessment consisted of flexion/extension plain film radiographs in four articles and both dynamic radiographs and computer tomography (CT) scan in one of the reviewed articles. Iliac Crest Bone Graft “ICBG” was the most common type of bone graft (3/5 articles) utilized, followed by demineralized bone matrix (DBM: 2/2), and bone morphogenetic protein (BMP: 1/5).

Conclusions:
Although PCLF is considered the standard of care for the management of multi-level degenerative cervical spine pathology, there is a paucity of literature specifically evaluating fusion rates associated with this common surgical intervention. The reported fusion rates, as well as the type of bone grafts utilized, varied widely in the published literature. Consequently, there is a need for high quality prospective clinical studies with large sample sizes to better assess the fusion rates after PCLF and determine the type of bone grafts or bone graft substitutes associated with a successful arthrodesis.