Lumbar pseudarthrosis: a review of current diagnosis and treatment

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Autologous chondrocyte grafting promotes bone formation in the posterolateral spine

“…Spinal fusion procedures have increased significantly over the past 10 years . While a successful spinal fusion rates have improved with modern implant and grafting techniques, complications can arise, with approximately 5% to 35% of all spinal fusions developing pseudoarthrosis . Pseudoarthrosis, or nonunion, may lead to increased patient morbidity such as continued pain, segmental instability, and need for revision surgery.…”

Effect of Pulsed Electromagnetic Field on the Consolidation of Posterolateral Arthrodeses in the Lumbosacral Spine: A Prospective, Double-Blind, Randomized Study

“…35 Studies using simple static radiography, 2,3,23 dynamic radiography, 36 computed tomography, 23,30 and clinical criteria, in particular the complaint of pain, 2 were found in the literature. In addition to the variety of methods, the interpretation of the results is occasionally subjective and has low reproducibility.…”

“…This method is currently regarded as the best non-invasive technique for diagnosing pseudarthrosis of the spine. 28,35 Recent studies comparing the accuracy of CT with surgical exploration for the assessment of lumbar arthrodesis consolidation showed sensitivities of 53% to 63% and specificities of 78% to 86%. 18,35 In our study, we interpreted the presence or absence of fusion using the Glassman method, 24,30 to which we added the correction of the coronal plane at each level of arthrodesis to be studied.…”

“…28,35 Recent studies comparing the accuracy of CT with surgical exploration for the assessment of lumbar arthrodesis consolidation showed sensitivities of 53% to 63% and specificities of 78% to 86%. 18,35 In our study, we interpreted the presence or absence of fusion using the Glassman method, 24,30 to which we added the correction of the coronal plane at each level of arthrodesis to be studied. 25 The specific orientation of the coronal plane for each level of consolidation assessment makes the interpretation of the Glassman method clearer and more reproducible, especially at levels where there is a greater vertebral slope, as in the lumbosacral transition.…”

“…26,28 The tomographic method with fine slices and volume acquisition was defined in recent studies as an option for assessment of the consolidation condition of lumbar arthrodesis. 2,35,37 We adopted CT with volume acquisition to define the occurrence of arthrodesis, performing the assessment with high-resolution monitors and the latest software. This method is currently regarded as the best non-invasive technique for diagnosing pseudarthrosis of the spine.…”