Scoliosis Research Society (SRS)
Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
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The Aging Spine

Pseudoarthrosis

The spine is made up of individual vertebra linked together by a disc in the front and two small joints in the back of the spine similar to the links in a watchband. The "links" or joints allow bending and twisting of the spine. These joints frequently become worn out, or arthritic, with aging or following injury and eventually become painful. If pain is not controlled with physical therapy, exercise and medication, a fusion may be suggested by your physician to stabilize the arthritic segment(s) of the spine.

Once a patient has decided to proceed with spinal fusion surgery then obtaining a solid fusion becomes the next area of focus. Pseudoarthrosis, which is derived from the Greek terms meaning "false joint," is a term used with the surgery does not result in a solid fusion. Better methods of selecting patients for surgery, as well as better surgical techniques have made pseudoarthrosis a much less common outcome of spinal fusion surgery.

Many patient issues are associated with an increased risk of pseudoarthrosis:

Other factors important to minimizing a failure of the fusion are related to the surgical technique such as, using bone graft from the patient (autologous graft), either from the spine itself (local graft) or from the hip region (iliac crest), and the use of modern instrumentation, including hooks, screws, cages, rods and wires, to properly align and stabilize the segments that the surgeon is attempting to fuse. Even in the hands of the best surgeons the risk of a pseudoarthrosis is at a minimum of 5% - 15%.

Symptoms
Your surgeon may have considerable difficulty determining if pseudoarthrosis has occurred. If a pseudoarthrosis has occurred, a recurrence of pain very similar in location to that before surgery will often be noted over a period of months, or the pain may gradually increase shortly after surgery.

Imaging
If spinal instrumentation was inserted during surgery, X-rays may demonstrate loosening or breakage of the instrumentation as shown in Figure 1. The best study to identify a pseudoarthrosis is a CAT or CT scan.
Treatment Options

If a painful pseudoarthrosis is identified, your spinal surgeon will make further recommendations for additional treatment, which may include additional surgery.

Pseudoarthrosis with broken instrumentation Pseudoarthrosis defect in fusion
Pseudoarthrosis with broken instrumentation Pseudoarthrosis defect in fusion
Repair of pseudoarthrosis with new instrumentation Repair of pseudoarthrosis with local bone graft
Repair of pseudoarthrosis with new instrumentation Repair of pseudoarthrosis with local bone graft

Reference Revision Surgery:
Failed Fusion - Pseudoarthrosis.
Retrieved November 28, 2006, from http://www.orthospine.com

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