Posterior Cervical Spinal Fusion for Recurrent Symptoms After ACDF

Clinical Assessment and Indications

The patient presents with recurrence of neck pain, bilateral arm pain, and headaches similar to symptoms before his cervical spine surgery, with MRI showing multilevel degenerative changes and mild spinal canal stenosis, and previous imaging indicating potential instability 1
Episodes of weakness and near-syncope after looking up without neck brace suggest possible instability or pseudarthrosis, with previous imaging showing anterolisthesis and retrolisthesis, indicating potential instability 2

Studies demonstrate that posterior approaches yield higher fusion rates (94%) compared to anterior revision approaches (76%) for treating anterior pseudarthrosis, with clinical outcomes significantly better with posterior revision, achieving excellent or good outcomes in 88% of patients 1
Posterior approaches have reported complication rates of approximately 8%, including nerve root palsies, and hardware failure rates are lower with posterior approaches (12%) compared to anterior (45%) or circumferential (28%) approaches 1

For patients with recurrent symptoms after cervical spine surgery, posterior approaches are recommended due to higher fusion rates and better clinical outcomes, allowing for decompression of neural elements while addressing potential instability 2
The posterior approach is particularly beneficial in cases with multilevel involvement and when previous anterior surgery has failed, with the use of spinal bone autograft and allograft morsel enhancing fusion potential, although this is based on a lower level of evidence from Praxis Medical Insights 3, 4

The American Association of Neurological Surgeons recommends that either posterior or anterior approaches be considered for surgical correction of anterior pseudarthrosis, with posterior approaches associated with higher fusion rates 5

Posterior approaches yield significantly better clinical outcomes in revision cases, achieving excellent or good outcomes in patients with pseudarthrosis or failed anterior procedures, according to the Journal of Neurosurgery guidelines 5