Pseudarthrosis in Primary Fusions for Adult Idiopathic Scoliosis: Incidence, Risk Factors, and Outcome Analysis

Abstract

Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with pseudarthrosis (P = 0.03). Smoking history and comorbidity did not increase the pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (> or =70 degrees) and a greater thoracic kyphosis (T5-T12 >40 degrees) did not correlate with a higher pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 > or =20 degrees) correlated with a significantly higher pseudarthrosis rate (P < 0.0001). Preoperative global sagittal and coronal imbalance did not increase the pseudarthrosis rate (P = 0.45 and 0.62, respectively). Patients with pseudarthrosis had lower SRS-24 scores than those without (P = 0.01). CONCLUSION.: The incidence of pseudarthrosis following adult idiopathic scoliosis primary fusion was 17%. The pseudarthrosis was most likely to occur at the thoracolumbar junction. Older patients (>55 years), longer fusion (>12 vertebrae), and those with thoracolumbar kyphosis (> or =20 degrees) demonstrated increased risk for pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the pseudarthrosis.

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

“…Even though pseudarthrosis has been reported as one of the most commonly documented reasons for reoperation, 6,9,10,13,[16][17][18] it is generally evaluated later than of 1 year after the index surgery. This study has focused on reoperation within 1 year and its effect on HRQOL.…”

“…6,11,12 Rates of reoperation are frequently cited, ranging from 10% to 25%, and among the many reasons behind reoperation-including infection, curve progression, proximal junction kyphosis, implant failure, and removal of painful implants 4,13,17 -pseudarthrosis emerges as one of the most commonly documented indications. 6,9,10,13,[16][17][18] There are also studies that have investigated the effects of demographic factors, suggesting older age as a risk factor for developing pseudarthrosis, with the consequent need for revision surgery. 1,5,7 However, few studies 9,10,19 have focused on the effects of reoperation and pseudarthrosis on patients' scores on outcome measures, including the SRS-22 and the ODI.…”

“…6,9,10,13,[16][17][18] There are also studies that have investigated the effects of demographic factors, suggesting older age as a risk factor for developing pseudarthrosis, with the consequent need for revision surgery. 1,5,7 However, few studies 9,10,19 have focused on the effects of reoperation and pseudarthrosis on patients' scores on outcome measures, including the SRS-22 and the ODI. While most of these studies address in detail the challenges of spine surgery that frequently result in reoperation, each examines a collection of individual issues, such as specific complications, risk factors, techniques to prevent reoperation, or outcome measures.…”

Anterior scoliosis surgery the state of art procedure

“…To best of the knowledge none of the studies till date has mentioned the incidence of screw pull out in anterior scoliosis surgery. 11,12 In a study by Brodner et al the patient group with thoracolumbar scoliosis anterior correction for the average 40 curve, the segments fused were 5.6 segments on an average. average number of segments fused was only 5 which is lower than the other studies were anterior only surgery was done.…”

BMP and Beyond: A 25-Year Historical Review of Translational Spine Research at Emory University

“…Despite state-of-the-art spinal instrumentation and techniques, failure of spinal fusion (pseudarthrosis) is still unfortunately a common complication, with a rate in primary fusions as high as 20% 1) . In addition, almost one-quarter of all revision arthrodesis surgeries are performed for a pseudarthrosis 2) .…”