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J Am Acad Orthop Surg, Vol 17, No 8, August 2009, 494-503.
© 2009 the American Academy of Orthopaedic Surgeons
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Pseudarthrosis of the Spine

Noah M. Raizman, MD, MFA, Joseph R. O’Brien, MD, MPH, Kirsten L. Poehling-Monaghan, BA and Warren D. Yu, MD

Dr. Raizman is Resident, Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC. Dr. O’Brien is Associate Director of Orthopaedic Spine Surgery, George Washington University Hospital, Washington, DC, and Assistant Professor, Departments of Orthopaedic Surgery and Neurosurgery, George Washington University School of Medicine. Ms. Poehling-Monaghan is Medical Student at George Washington University School of Medicine. Dr. Yu is Chief of Spine Surgery, George Washington University Hospital, and Associate Professor, Departments of Orthopaedic Surgery and Neurosurgery, George Washington University School of Medicine.

Dr. Raizman or a member of his immediate family has stock or stock options held in GlaxoSmithKline. Dr. O’Brien or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker and DePuy, serves as a paid consultant to or is an employee of DePuy, and has received research or institutional support from DePuy and Stryker. Dr. Yu or a member of his immediate family serves as a paid consultant to or is an employee of Zimmer and Kyphon and has received research or institutional support from Medtronic, Johnson & Johnson, and Stryker. Neither Ms. Poehling-Monaghan nor a member of her immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. O’Brien, Department of Orthopaedic Surgery, George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, 7th Floor, Washington, DC 20037.

Pseudarthrosis is the result of failed attempted spinal fusion. This condition typically manifests with axial or radicular pain months to years after the index operation. Diagnosis is based on clinical presentation and imaging studies, after other causes of persistent pain are ruled out. The degree of motion seen on flexion-extension radiographs that is indicative of solid or failed fusion remains a point of controversy. Thin-cut CT scans may be more reliable than radiographs in demonstrating fusion. Metabolic factors, patient factors, use and choice of instrumentation, fusion material, and surgical technique have all been shown to influence the rate of successful fusion. Treatment of the patient with symptomatic pseudarthrosis involves a second attempt at fusion and may require an approach different from that of the index surgery as well as the use of additional instrumentation, bone graft, and osteobiologic agents.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.