Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up

Abstract

Objective Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection. Methods Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/ six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5–10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed. Results Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales ( p <0.05). Conclusion Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.

Should Implant Breakage Be Always Considered as Implant “Failure” in Spine Surgery: Analysis of Two Cases and Literature Review

“…To the best of our knowledge, there is only one study [12] available that shows the five-year follow-up of non-operative management of pseudoarthrosis of 19 patients presented with rod breakage after pedicle subtraction osteotomy. In this study, all patients presented with either single or both rod breakage.…”

Biomechanical comparison of multi-rod constructs by satellite rod configurations (in-line vs. lateral) and screw types (monoaxial vs. polyaxial) spanning a lumbar pedicle subtraction osteotomy (PSO): is there an optimal configuration?

“…While providing significant correction, they are associated with a relatively high rate of short-and long-term complications [1,2]. Two of importance are pseudarthrosis and rod breakage, which have been reported as the most common postoperative complications and frequent indications for revision operations [2][3][4][5][6][7][8][9][10][11]. In an attempt to decrease their rates, a variety of supplementary surgical techniques have been evaluated and implemented.…”

Failures in Thoracic Spinal Fusions and Their Management

“…A recent series of patients with pseudarthrosis following pedicle subtraction osteotomies in the lumbar spine, a highly destabilizing operative technique, found that patients managed nonoperatively did well at longterm follow-up, as long as focal instability did not alter the patient's global alignment and an appropriate sagittal vertical axis (SVA) was maintained. 6 Additionally, revision surgery for pseudoarthrosis carries significant intrinsic risk, and is reported to have a failure rate of 40 to 70%. 7 Nevertheless, in the correct clinical scenario, where the patient experiences increasing pain or decline in neurologic or functional status, revision surgery may be appropriate.…”