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Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick

Recommendations It is recommended that the physician evaluate for the presence of pseudarthrosis if the clinical outcome is poor and it is suspected that there is an association between the outcome and a pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (quality of evidence, Class III; strength of recommendation, D). Indications: Pseudarthrosis It is recommended that revision of a symptomatic pseudarthrosis be considered because

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Abolfazl Rahimizadeh, Housain Soufiani, Valliolah Hassani, and Ava Rahimizadeh

D EPOSITION of ochronotic material in intervertebral discs of patients with alkaptonuria results in disc degeneration and marginal intervertebral bridge formation, which eventually causes spinal stiffness and ultimately ankylosis, quite similar to seronegative spondyloarthropathies. 1 , 4 , 5 , 10 , 19 , 40 , 43 , 54 , 59 Pseudarthrosis, designated as Andersson disease, is a well-known complication of a long-standing ankylosing spondylitis (AS). 7 , 11 , 50 , 57 , 67 , 68 , 71 Actually, pseudarthrosis is a mobile nonunion state that usually occurs at

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Stephen L. Ondra and Shaden Marzouk

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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Domagoj Coric, Charles L. Branch Jr., and Jeffrey D. Jenkins

A nterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, opacified posterior longitudinal ligament, and degenerative disc disease. 3, 4, 13, 16, 17, 21, 25, 48 Pseudarthrosis, or failure of fusion, may be the most common complication associated with spinal fusion procedures. The diagnosis of pseudarthrosis is not always straightforward, and the optimum imaging modality in the absence of frank instability remains controversial

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Stephen M. Bergin, Timothy Y. Wang, Christine Park, Shashank Rajkumar, C. Rory Goodwin, Isaac O. Karikari, Muhammad M. Abd-El-Barr, Christopher I. Shaffrey, Chester K. Yarbrough, and Khoi D. Than

A nterior cervical discectomy and fusion (ACDF) is the most commonly performed surgery for cervical radiculopathy and myelopathy. 1 Pseudarthrosis is the failure of bony fusion to occur, and the resulting nonunion is associated with worse clinical outcomes and higher costs, although the exact clinical significance of radiographically diagnosed pseudarthrosis remains controversial. 2 , 3 The etiology of pseudarthrosis following ACDF is multifactorial, and known predictors include multilevel ACDFs, osteoporosis, chronic kidney disease, and smoking status

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Michael M. Safaee, Cecilia L. Dalle Ore, Corinna C. Zygourakis, Vedat Deviren, and Christopher P. Ames

correction has inevitably led to a rise in the number of revision surgeries. 29 , 33 Pseudarthrosis, the failure to obtain a solid fusion after surgery, is a well-recognized complication and a major indication for surgical revision. 18 , 29 The incidence varies based on surgical approach, underlying pathology, and other patient-related factors; reported rates of pseudarthrosis following surgery for ASD range from 15% to 22%. 21–24 Recent studies have shown that longer construct length and increased sagittal imbalance have been associated with a higher risk for

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Darryl Lau, Dean Chou, John E. Ziewacz, and Praveen V. Mummaneni

independent risk factor for perioperative complications. 14 What is currently known about the effects of smoking on patient outcomes following spine surgery is almost entirely derived from long-term outcome measures. It has been shown that smoking is associated with poor bone quality, 30 lower fusion rates, 7 delayed fusion, 18 and increased likelihood of pseudarthrosis following spinal instrumentation and fusion. 34 There is only 1 recently published study assessing the relationship of smoking and perioperative outcomes following spine surgery. 29 In this study we

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Yakov Gologorsky, Branko Skovrlj, Jeremy Steinberger, Max Moore, Marc Arginteanu, Frank Moore, and Alfred Steinberger

fusion after posterior lumbar interbody surgery. They concluded that when plain radiographs show strong evidence of fusion or pseudarthrosis, CT is unlikely to provide useful new information and might be indicated for unclear cases only. 11 If progressive bony healing was not noted on radiographs after 1 year, a diagnosis of pseudarthrosis was made ( Fig. 1 ). F ig . 1 Pseudarthrosis. Reconstructed coronal CT images showing horizontal linear lucencies that traverse the fusion masses at L4–5 (arrows) through the disc space (upper) and intertransverse

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Nicholas D. D’Antonio, Mark J. Lambrechts, Jeremy C. Heard, Yunsoo Lee, Hannah Levy, Garrett Breyer, Goutham R. Yalla, Meera Kohli, Tristan Fried, John J. Mangan, Jose A. Canseco, Barrett Woods, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, and Gregory D. Schroeder

more levels of height loss may have a decreased risk of pseudarthrosis, which itself may positively impact PROMs, including scores for the Neck Disability Index (NDI) and the visual analog scale (VAS) for neck pain (VAS-Neck) and arm pain (VAS-Arm). 11 To determine the effect of postoperative disc height loss on surgical and clinical outcomes in the present study, we aimed to address the following objectives: 1) determine if postoperative disc height loss is associated with the rate of pseudarthrosis following ACDF, 2) determine if the amount of postoperative disc

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Eduardo A. Iunes, Enrico A. Barletta, Telmo A. B. Belsuzarri, Franz J. Onishi, André Y. Aihara, Sergio Cavalheiro, and Andrei F. Joaquim

anchoring tips (inserted into the vertebral bodies of the adjacent segments) similar to a plate and screws, offering immediate stabilization after surgery, restoring cervical lordosis and avoiding plate-related complications. 13–15 Nonetheless, there is disagreement regarding the use of self-locking, stand-alone cages since complications, such as pseudarthrosis and subsidence, have been reported, 16 , 17 as well as device migration and loss of cervical lordosis. 18 In this context, the objective of this study was to evaluate the incidence of pseudarthrosis after 1- to 3