A failed fusion (called a pseudoarthrosis) in a two level ACDF (anterior cervical decompression and fusion) is not uncommon with some papers noting as much as a 20% failure rate. This failure rate is partially based upon the type of graft used.
As failure of fusion is not uncommon, there are standard techniques to resolve this failure. Some pseudoarthoses are stable/not painful and patients can live with them without any lifestyle alterations. These fusion failures have tough fibrous tissue binding them and demonstrate little motion.
Some pseudoarthoses allow significant motion and are painful. If enough time has passed and there is no fusion, there are two ways to allow these to heal. If the body demonstrates a significant attempt to heal (this can be determined by a CT scan) and there are no bone spurs that are compressing the nerves or cord, a posterior fusion generally allows both the back and front of the neck to heal.
If however, there is a very poor attempt by the vertebra to incorporate the fusion (as indicated by CT scan) or there are spurs compressing the nerve roots or cord, an anterior revision and a posterior fusion needs to be considered.
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.