Revision strategies for lumbar pseudarthrosis

Stephen L. OndraDepartment of Neurosurgery, Northwestern University, Chicago, Illinois; and Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan

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Shaden MarzoukDepartment of Neurosurgery, Northwestern University, Chicago, Illinois; and Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan

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Management and avoidance of lumbar pseudarthrosis are among the most common and challenging tasks faced by reconstructive spine surgeons. The risks of peudarthrosis can be broadly divided into two categories: those within a surgeon's control and those not within his/her control. These include biological factors, graft choices, site preparation, and surgical design. The authors review the biological factors that affect fusion and how they can be manipulated to avoid or manage lumbar pseudarthrosis. Surgical planning and construct design to prevent or treat pseudarthrosis will also be discussed. Additionally, the importance of restoring sagittal balance will be reviewed.

Abbreviations used in this paper:

BMP = bone morphogenetic protein; NSAID = nonsteroidal antiinflammatory drug.

Management and avoidance of lumbar pseudarthrosis are among the most common and challenging tasks faced by reconstructive spine surgeons. The risks of peudarthrosis can be broadly divided into two categories: those within a surgeon's control and those not within his/her control. These include biological factors, graft choices, site preparation, and surgical design. The authors review the biological factors that affect fusion and how they can be manipulated to avoid or manage lumbar pseudarthrosis. Surgical planning and construct design to prevent or treat pseudarthrosis will also be discussed. Additionally, the importance of restoring sagittal balance will be reviewed.

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