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Pseudarthrosis in adult spine deformity surgery: risk factors and treatment options

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Abstract

Purpose

Highlight risk factors for pseudarthrosis in long-segment spinal fusions, collect the approaches carried to address this complication.

Methods

Patients with ASD and fusion of ≥ 4 levels with minimum follow-up (FU) of ≥ 2 years were included. Full-body X-rays were done preoperatively, < 3 months and ≥ 2 years. Oswestry disability index (ODI), Scoliosis Research Society-22 and SF36 assessed pre- and postoperatively. The relationship between demographic, surgical and radiological variables with the development of pseudarthrosis was evaluated.

Results

Out of 524 patients included, 65 patients (12.4%) developed pseudarthrosis and 53 underwent revision surgery. Notably, 88% of pseudarthrosis cases are associated with fusion length (OR = 1.17, 95% CI = 1.05–1.292, p = 0.004), osteotomy requirement (OR = 0.28, 95% CI = 0.09–0.85, p = 0.025), pelvic fixation (OR = 0.34, 95% CI = 0.13–0.88, p = 0.026) and combined approaches (OR = 3.29, 95% CI = 1.09–9.91, p = 0.034). Sagittal alignment is not related to the rate of pseudarthrosis. Health related and quality of life scores were comparable at last FU between patients revised for pseudarthrosis and those that didn’t require revision surgery (ODI = 28% no revision and 30% revision group).

Conclusions

Pseudarthrosis is not related to malalignment, but with the surgical techniques employed for its treatment. Anterior approaches with anterior support decrease the rate by 30%, while long fusions, osteotomies and pelvic fixation increase its rate.

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Acknowledgements

Glynny Kieser for her editorial input.

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Authors and Affiliations

  1. Serviço de Ortopedia, Unidade Local de Saúde do Litoral Alentejano, Santiago do Cacem, Portugal

    Manuel Fernandes Marques

  2. Spinal Unit, Santy Orhopaedic Center and Mermoz Hospital Ramsay GDS, Lyon, France

    Vincent Fiere

  3. Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France

    Ibrahim Obeid & Louis Boissiere

  4. Clinique du Dos-Bordeaux and ELSAN Polyclinique Jean Villar, 33520, Bruges, France

    Ibrahim Obeid & Louis Boissiere

  5. Department of Spine Surgery, Strasbourg University Hospital, 1, place de l’Hôpital, BP 426, 67091, Strasbourg Cedex, France

    Yann-Philippe Charles

  6. Chirurgie Orthopedique et Traumatologique – Clocheville, Centre Hospitalier Regional Universitaire de Tours, Tours, France

    Khaled El-Youssef

  7. Neurosurgery Department, Sainte-Anne Hospital, Paris, France

    Abi Lahoud & Joe Faddoul

  8. Department of Orthopaedic Surgery, Hôpital Georges Pompidou, 75015, Paris, France

    Emmanuelle Ferrero

  9. Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, 75014, Paris, France

    Guillaume Riouallon

  10. CMR Des Massues, 92 Rue Dr Edmond Locard, 69005, Lyon, France

    Clément Silvestre

  11. Orthopédie-Traumatologie Department, Polyclinique Bordeaux Nord Aquitaine, 33000, Bordeaux, France

    Jean-Charles Le Huec

  12. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, Christchurch, 8011, New Zealand

    David Kieser

Authors
  1. Manuel Fernandes Marques
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  2. Vincent Fiere
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  9. Guillaume Riouallon
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  13. Louis Boissiere
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Correspondence to David Kieser.

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Marques, M.F., Fiere, V., Obeid, I. et al. Pseudarthrosis in adult spine deformity surgery: risk factors and treatment options. Eur Spine J 30, 3225–3232 (2021). https://doi.org/10.1007/s00586-021-06861-w

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  • DOI: https://doi.org/10.1007/s00586-021-06861-w

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