Background: Anterior cervical decompression and fusion (ACDF) may necessitate acute and late re-operations. Published long-term follow studies after ACDF are scarce.
Objective: Our goal was to give a detailed description of early and late re-operations after ACDF in an 11-year follow-up.
Methods: We retrospectively analyzed all available clinical data, including radiographic imaging for all patients who underwent an ACDF at our institution between 1998 and 1999. ACDF without plating was performed in 327 patients. All re-operations were performed at our institution.
Results: Forty-nine patients (15 %, CI 12-19 %) underwent a re-operation; 16 (4.9 %, CI 3-8 %) during the first month and 36 (11 %, CI 8-15 %) later during the follow-up. Five early re-operations were due to postoperative hematomas. No anterior transition of cages was detected. Asymptomatic cage subsidence was seen in 21 re-operated patients, but only one (0.3 %, CI 0-2 %) resulted in a re-operation. Adjacent level re-operation was performed for 26 patients (8 %, CI 5-11 %). This was independent of the number of fused levels or the localization of fusion. Plate reinforcement was used in only two patients in addition to ACDF; both of them were re-operations. The outcome was reported good or excellent for 11 (69 %, CI 44-86 %) and 26 (72 %, CI 56-84 %) patients with an early and late re-operation, respectively.
Conclusion: Fifteen percent of patients underwent a re-operation during the follow-up. The outcome for re-operated patients is similar to patients without a re-operation. A multilevel fusion does not predispose to adjacent level degeneration. A solid fusion can be achieved without plating.