Pseudarthrosis of the Lumbar Spine

Larsen, John M.; Capen, Daniel A.

doi:10.5435/00124635-199705000-00004

Cited by 37 publications

(23 citation statements)

References 21 publications

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“…The primary principles include stabilization of the existing posterior fixation by replacing the loose fixation points, which is followed by regrafting. 44 Zdeblick demonstrated that patients undergoing lumbosacral fusion for degenerative spine conditions had significantly higher fusion rates if they underwent combined autogenous bone graft with a rigid pedicle screw/rod fixation system versus autogenous bone graft only. 60 Another attractive option would be to consider interbody fusion in the setting of posterolateral lumbar nonunion.…”

Section: Surgical Strategiesmentioning

confidence: 99%

“…While the physical examination is generally nonspecific, there may be a spinal deformity present due to the loss of anatomical correction and alignment secondary to fusion failure. 28,41,44,46,52 A patient who denies any significant symptom relief postoperatively should be studied further to rule out differential diagnoses.…”

Section: Surgical Strategiesmentioning

confidence: 99%

“…Despite this, it is often difficult to predict when or if a pseudarthrosis will become symptomatic for the patient. 44,52 DePalma and Rothman 16 retrospectively compared outcomes in patients with radiographic evidence of lumbar pseudarthrosis to a matched cohort with successful lumbar fusion. They found no significant difference between the 2 groups with regard to return to activity, symptom relief, and subjective satisfaction with the surgery.…”

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confidence: 99%

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Lumbar pseudarthrosis: a review of current diagnosis and treatment

Chun

Baker

Hsu

2015

FOC

147

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OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I–III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.

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Section: Surgical Strategiesmentioning

confidence: 99%

Section: Surgical Strategiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Lumbar pseudarthrosis: a review of current diagnosis and treatment

Chun

Baker

Hsu

2015

FOC

147

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“…In the literature, it was reported that the success rates of fusion decreased and the risk of pseudoarthrosis increased in chronic diseases such as smoking, osteopenic bone structure, thyroid and growth hormone deficiency, chronic renal failure (26,27).When our case series are analyzed,it is observed that chronic disease did not affect the formation of spinal fusion. In fact, this may seem like a reverse situation with literature.…”

Section: Discussionmentioning

confidence: 80%

Short and Medium Term Results of Posterior Segmental Instrumentation and Posterolateral Fusion in Female Patients with Spondylolisthesis: A Clinical Trial

Kızılay¹,

Topçu²,

Aydin³

et al. 2018

meandros

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Objective: Aim of this study was to short and medium term results of posterior segmental instrumentation and posterolateral fusion in female patients with spondylolisthesis. Materials and methods:Patients with lumbar sponylolisthesis who were performed convetional laminectomy, poliaxial secrew fixation and posterolateral fusion between the 2013 and 2015. The postoperative fusion of the female patients were evaluated through Lumbar 3D Computed Tomography and X-Ray imaging. The patients' low back pain and lower extremities's pain were evaluated with Oswestry disability index and Visual Analogue Score. Retrospective Patients' information were collected via file in May 2016. Result: When the pain scores of the patients who underwent segmental instrumentation were compared in the preoperative, postoperative periods there was the significant decrease in pain scores (p<0.001). Conclusion:The posterolateral fixation and fusion are an efficient treatment method in the medium and short term in female patients with spondylolisthesis. But, a secondary chronic disease such as osteoporosis associated with aging was added to impair bone quality, fusion success rate was seen to be decreased.

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“…Although multiple improvements in the surgical technique have led to higher fusion rates, failed back surgery syndrome remains a substantial problem [ 6 ]. Pseudarthrosis is defined as the absence of solid bony fusion 1 year after the operation, and occurs in at least 15 % of primary lumbar fusions [ 7 , 8 ]. Pseudarthrosis is typically associated with LBP or radicular pain as a result of continued motion [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT

Peters

Willems

Weijers

et al. 2015

Eur J Nucl Med Mol Imaging

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PurposePainful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of 18F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain.MethodsA cohort of 36 patients was retrospectively included in the study after 18F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 – 263 MBq (mean 199 MBq, median 196 MBq) 18F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following 18F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores.ResultsNo correlation was found between symptom severity and fusion status. However, 18F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04).ConclusionWe hypothesize that 18F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the ‘stress reaction’ at the vertebral endplates which significantly correlates with Oswestry Disability Index score.

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Pseudarthrosis of the Lumbar Spine

Cited by 37 publications

References 21 publications

Lumbar pseudarthrosis: a review of current diagnosis and treatment

Lumbar pseudarthrosis: a review of current diagnosis and treatment

Short and Medium Term Results of Posterior Segmental Instrumentation and Posterolateral Fusion in Female Patients with Spondylolisthesis: A Clinical Trial

Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT

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