Does Additional Uncinate Resection Increase Pseudarthrosis Following Anterior Cervical Discectomy and Fusion?

Study Design. Retrospective comparative study. Objective. To investigate whether unilateral or bilateral uncinate resection (UR) combined with anterior cervical discectomy and fusion (ACDF) increases the risk of pseudarthrosis at long-term follow-up. Summary of Background Data. Uncoforaminotomy (or UR), performed along with ACDF, facilitates better and faster improvement of arm pain. As uncovertebral joints are important for maintaining stability, they may affect the fusion process by causing segmental instability if resected during ACDF. Methods. We retrospectively examined 167 patients (89 men, 78 women; mean age, 58.4 ± 10.5 yr) who consecutively underwent single- or double-level ACDF and were followed for >2 years. UR was not performed in 46 patients (N-UR group). UR of at least one foramen was performed in 121 patients (UR group), including unilateral UR in 89 patients (U-UR group) and bilateral UR in 32 patients (B-UR group). Demographic data, fusion rate, visual analog scale (VAS) scores for neck/arm pain, and neck disability index (NDI) scores were compared between the N-UR and UR groups. Moreover, the fusion rates after the single- and double-level procedures were compared among the groups. Results. There was no difference in sex, age, weight, height, body mass index (BMI), and smoking history between the N-UR and UR groups. The fusion rates after single-level ACDF were not significantly different among the N-UR, U-UR, and B-UR groups (91.4%, 97.8%, and 88.2%; P = 0.290). Solid fusion was achieved in all groups after double-level ACDF (72.7%, 95.5%, and 86.7%), although the rates did not significantly differ among the groups (P = 0.071). The improvement in the VAS score for arm pain was significantly better in the UR group than in the N-UR group at short-term follow-up (P < 0.001). Conclusion. Unilateral or bilateral UR does not affect the fusion rate after single- or double-level ACDF. Hence, if necessary, additional UR can be performed during ACDF without concern regarding nonunion. Level of Evidence: 4

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