Revision Surgery for Failed Cervical Spine Reconstruction

HSS Journal Volume 11, Number 1 February, 2015

John D. Koerner, MD

Rothman Institute, Thomas Jefferson University and Hospital, Philadelphia, PA

Christopher K. Kepler, MD, MBA

Rothman Institute, Thomas Jefferson University and Hospital, Philadelphia, PA

Todd J. Albert, MD
Todd J. Albert, MD

Surgeon-in-Chief and Medical Director, Hospital for Special Surgery
Chairman, Department of Orthopedic Surgery, Weill Cornell Medical College
Professor of Orthopedic Surgery, Weill Cornell Medical College



As the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Surgeons need to understand the etiology of post-surgical changes, as well as have a treatment algorithm when evaluating these complex patients.


This study aims to review the rates and etiology of revision cervical spine surgery as well as describe our treatment algorithm.

Patients and Methods

We used a narrative and literature review. We performed a MEDLINE (PubMed) search for “cervical” and “spine” and “revision” which returned 353 articles from 1993 through January 22, 2014. Abstracts were analyzed for relevance and 32 articles were reviewed.


The rates of revision surgery on the cervical spine vary by the type and extent of procedure performed. Patient evaluation should include a detailed history and review of the indication for the index procedure, as well as lab work to rule out infection. Imaging studies including flexion/extension radiographs and computed tomography are obtained to evaluate potential pseudarthrosis. Magnetic resonance imaging is helpful to evaluate the disc, neural elements, soft tissue, and to differentiate scar from infection. Sagittal alignment should be corrected if necessary.


Recurrent or new symptoms after cervical spine reconstruction can be effectively treated with revision surgery after identifying the etiology, and completing the appropriate workup.

This work was performed at the Rothman Institute, Thomas Jefferson University and Hospital, Philadelphia, PA.

This article appears in the HSS Journal: Volume 11, Issue 1.
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About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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