Revision ACDF at the same level

Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for cervical spondylosis and numerous other pathologies resulting in compression of the spinal canal and neural foramen. In the case of a single-level ACDF, which has a very high fusion rate, the lack of a successful fusion should prompt a workup in the clinic to establish causative factors. Computed tomography should be obtained in all candidates being considered for revision surgery because it provides indispensable information on the assessment of bone quality and bony fusion. Postoperative management must be directed by the etiology that made a revision necessary, the preoperative pathology, the extent of fusion, and the patient's risk factors. Revision of ACDF generally carries a higher risk for complications than the initial procedure. This includes intraoperative injuries of the neurovascular or tracheoesophageal structures, as well as early and delayed complications discussed previously.