Failure in Lumbar Spinal Fusion and Current Management Modalities

Alex Cruz; Alexander E. Ropper; David S. Xu; Michael Bohl; Edward M. Reece; Sebastian J. Winocour; Edward Buchanan; Geoffrey Kaung

doi:10.1055/s-0041-1726102

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2021; 35(01): 054-062
DOI: 10.1055/s-0041-1726102

Review Article

Failure in Lumbar Spinal Fusion and Current Management Modalities

Alex Cruz

¹Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas

,

Alexander E. Ropper

²Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

,

David S. Xu

²Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

,

Michael Bohl

³Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

,

Edward M. Reece

²Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

⁴Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

,

Sebastian J. Winocour

⁴Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

,

Edward Buchanan

⁴Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

⁵Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Geoffrey Kaung

¹Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas

› Author Affiliations

Abstract

Lumbar spinal fusion is a commonly performed procedure to stabilize the spine, and the frequency with which this operation is performed is increasing. Multiple factors are involved in achieving successful arthrodesis. Systemic factors include patient medical comorbidities—such as rheumatoid arthritis and osteoporosis—and smoking status. Surgical site factors include choice of bone graft material, number of fusion levels, location of fusion bed, adequate preparation of fusion site, and biomechanical properties of the fusion construct. Rates of successful fusion can vary from 65 to 100%, depending on the aforementioned factors. Diagnosis of pseudoarthrosis is confirmed by imaging studies, often a combination of static and dynamic radiographs and computed tomography. Once pseudoarthrosis is identified, patient factors should be optimized whenever possible and a surgical plan implemented to provide the best chance of successful revision arthrodesis with the least amount of surgical risk.

Keywords

lumbar spinal fusion - neurosurgery - spine surgery - pseudoarthrosis

Full Text

References

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