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PubMed1987

[Comparative results of compression and non-compression operation methods following medial femoral neck fracture].

This is a personal clinical and radiological follow-up of 65 patients with fractures of the femoral neck who were treated in 1973 to 1984 at our hospital. 30 patients were operated by nailing according to Smith-Petersen and in 35 patients osteosynthesis was performed by means of three or four lag screws. A comparative study between these two methods was done. The two main complications of femoral neck fracture, a vascular head necrosis and pseudarthrosis, were of special interest. The mean follow-up time was 7.2 years with the fracture fixed by nailing and 4.1 years, with the fractures operated by lag screws. Out of the 65 patients the total rate of femoral head necroses was 21.5% and 10.7% of pseudarthrosis. In the fractures treated by the nailing method the rate of necrosis was 23.3% and the rate of pseudarthrosis 13.3%. In the fractures operated by lag screws the incidence of head necrosis was 20% and 8.5% by pseudarthrosis. Fracture displacement was primarily responsible for the development of aseptic necrosis, but we could see also a relation between head necrosis and the inclination of the fracture line. Fractures of the type PIII/GIII/IV are those with the highest rate of avascular necrosis. Furthermore, the development of both, aseptic necrosis and pseudarthrosis, is strongly influenced by incomplete reduction.

Adult↗

PubMed1997

Freeze-dried allograft for posterior spinal fusion in patients with neuromuscular spinal deformities.

STUDY DESIGN: The effectiveness and safety of freeze-dried allograft for posterior spinal fusion in patients with neuromuscular disorders were evaluated retrospectively. SUMMARY OF BACKGROUND DATA: Because the harvest of an adequate quantity of autogenous bone graft from patients with neuromuscular deformity who have instrumentation and fusion to the pelvis is difficult at best, an alternative graft source usually is needed. Allograft bone, most commonly processed fresh-frozen or freeze-dried, has been used frequently for posterior spinal fusion in patients with neuromuscular deformity. However, a relatively high risk of infection and pseudarthrosis has been reported for this procedure. METHODS: Forty patients with neuromuscular deformity with an average age at the time of surgery of 14 years and 2 months (range, 5 years, 4 months to 23 years, 8 months) met the inclusion criteria. All of these patients underwent more than 2 years of follow-up evaluation. They were evaluated for rates of infection, pseudarthrosis, and transmissible disease. RESULTS: Thirty-eight patients had solid fusion at the most recent follow-up visit. Definite pseudarthrosis was detected in one patient (2.5% of the study group), which was treated successfully. Another patient's (2.5%) spinal curve progression of more that 10 degrees and rod breakage led the authors to diagnoses a probable pseudarthrosis. She had a stable spine that did not require revision at 68 months after surgery. For the 32 patients who underwent posterior surgery only, the pseudarthrosis rate was 3.1%. There were no acute deep wound infections. Superficial infection occurred in two patients (5%) and delayed deep sterile drainage in one patient (2.5%). All cases of infection resolved with appropriate management. Delayed deep wound infection developed in one patient (2.5%) as a result of staphylococcus coagulase negative at 34 months after surgery. Successful treatment has consisted of implant removal, debridement, and appropriate antibiotics. Transmissible disease attributable to allograft has not been detected to date. CONCLUSION: Freeze-dried allograft fusion is a reliable and effective method for posterior spinal fusion in the patients with neuromuscular deformity.

Adolescent↗

PubMed1999

Hardware failure in an unconstrained lumbar pedicle screw system. A 2-year follow-up study.

STUDY DESIGN: A consecutive study of patients who underwent lumbar spinal arthrodesis with an unconstrained pedicle screw system. OBJECTIVES: To determine the rate of arthrodesis and of clinical success and to examine and characterize the cases of hardware failure with the AO/Dynamic Compression Plate system (Synthes, Paoli, PA). SUMMARY OF BACKGROUND DATA: Although the advantages and disadvantages of nonconstrained versus constrained systems have been studied extensively, instrumentation failure has not. Additionally, the association between pseudarthrosis and hardware failure per se is unclear. METHODS: Seventy-four consecutive cases of lumbar spinal fusion are reviewed. Standard outcome scores based on pain relief and medication usage were tabulated, along with pertinent demographic data. The patients were observed at five intervals after surgery for at least 2 years (range, 24 to 35 months; mean, 27 months). Standard statistical analyses were used to analyze data. Status of the arthrodesis was determined by standard radiographic criteria. RESULTS: The overall fusion rate was 61%. At final follow-up, 60% of patients believed that their back pain had improved, whereas 70% believed that their limb pain had improved. The presence of a solid fusion (r = 3.3, P = 0.010) was correlated positively with a successful clinical outcome; the presence of pseudarthrosis and preoperative narcotic use were negatively correlated with a successful clinical outcome. Twenty-two percent of patients (16) experienced hardware failure. Twelve of the 16 had pseudarthrosis; in the majority of these patients, hardware failure occurred at the level of the pseudarthrosis. CONCLUSIONS: The results of this study demonstrate an extremely high rate of hardware failure and pseudarthrosis using an unconstrained pedicle screw system. Interestingly, the initial rate of pain relief was higher and declined over time and was quite possibly associated with loosening of the hardware. Based on these data, it is difficult to recommend the use of an unconstrained fixation system in the lumbar spine.

Bone Screws↗

PubMed2006

Allograft versus no graft with a posterior multisegmented hook system for the treatment of idiopathic scoliosis.

STUDY DESIGN: A prospective, randomized study. OBJECTIVE: To compare the clinical results of posterior spinal fusion (PSF) with allograft augmentation versus no graft for patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The use of allograft has become a standard means of augmenting a PSF. Many studies have shown equal rates of fusion when comparing allograft with autogenous iliac crest. There have been no studies to directly compare the results obtained with allograft with those achieved without the use of any bone graft at all. METHODS: Ninety-one patients with AIS were randomized into two treatment groups. Seventy-six patients had greater than 2-year follow-up and are included in this review. The Allograft Group consisted of 37 patients who underwent a standard PSF using a multisegmented hook-screw and rod system with the use of corticocancellous allograft for augmentation. The No Graft Group included 39 patients with AIS who underwent the same procedure without any bone graft. All autogenous bone resulting from a thoracoplasty and any local bone (for example, that removed from spinous processes) was discarded in both groups. Patients with at least 2 years of radiographic and clinical follow-up were evaluated using established criteria for possible or definite pseudarthrosis. Treatment groups were similar with respect to age, preoperative deformity, and correction obtained. RESULTS: The overall definitive pseudarthrosis rate for this study was 1.3% (1 of 76 patients). The 1 patient with pseudarthrosis was in the Allograft Group (1 of 37, or 2.7%, P = 0.98 as defined by our criteria), versus none of 39 in the No Graft Group. Two patients in each group (5.4% in the Allograft Group and 5.1% in the No Graft Group) met the radiographic criteria for possible pseudarthrosis. This establishes a P value of 0.65 comparing risk of possible pseudarthrosis in the two groups. CONCLUSION: Our results suggest that a PSF using newer-generation multisegmented hook-screw and rod systems can be successful with allograft and/or local bonegraft without the use of supplemental autogenous bone graft (from the iliac crest or ribs) in patients with AIS.

Adolescent↗

PubMedDate not supplied

Results of hip arthrodesis in adolescents by using the cobra-head plate for internal fixation.

A retrospective study was conducted to examine the efficacy and potential morbidity of hip fusion using the Cobra-head plate in adolescents. A heterogeneous group of 11 adolescents, with recalcitrant hip pain and an average age of 14.6 years, underwent unilateral hip arthrodesis with the Cobra-head plate for internal fixation. Seven (64%) patients achieved an uneventful clinical and radiographic arthrodesis after a mean postoperative interval of 7.4 months. Four index operations (36%) were complicated by pseudarthrosis. All patients who developed a postoperative pseudarthrosis ranked at or above the 90th percentile for their age-determined weight. The relationship between the percentile-weight-for-age and the incidence of pseudarthrosis was statistically significant (p < or = 0.001). Hip-arthrodesis procedures with the Cobra-head plate in adolescents at or above the 90th percentile weight-for-age are associated with an unacceptably high rate of pseudarthrosis. In this subset of patients, alternate or supplementary stabilization methods should be considered.

Adolescent↗

PubMedDate not supplied

The mechanical consequence of failure of ossified union in attempted posterior spinal fusion. A canine model.

The mechanical behavior of pseudarthrosis in posterior spinal fusion was investigated. A canine model was developed in which an incompletely ossified posterior fusion mass was consistently produced. The spines were excised, and the motion segments were mechanically tested using a specially developed loading apparatus. Tests were performed to evaluate stiffness of the segments to loading with compression, torsion, and anterioposterior and lateral bending shear stiffness. Changes in other modes of loading were less consistent. The motion characteristics of the pseudarthrosis could not be predicted from the extent of the osseous defect noted on roentgenograms. These findings correlate clinically with the progression of curvature seen with pseudarthrosis in scoliosis surgery and the unpredictable results of pseudarthrosis in posterior fusion performed in treatment of degenerative disc disease.

Animals↗

PubMed1992

Revision surgery for failed back surgery syndrome.

Results of surgical treatment in 50 failed back surgery patients were retrospectively reviewed to determine what factors influenced surgical outcome. Before surgery, all patients had disabling pain and limited function. Overall significant improvement in pain and function was obtained in 66% of the patients. Thirteen of 16 patients (81%) who had successful fusion of pseudarthrosis had a satisfactory outcome, whereas only 3 of 13 patients (23%) who had failed pseudarthrosis repair had a satisfactory outcome. Successful pseudarthrosis repair is the key to a high clinical success rate in revision surgery for failed back surgery syndrome. Pseudarthrosis repair by conventional posterolateral fusion with postoperative lumbosacral corset immobilization showed a high failure rate. The success rate of reoperation on failed back surgery syndrome patients is low.

Adult↗

PubMed1992

Repair of symptomatic pseudoarthrosis of anterior cervical fusion. Posterior versus anterior repair.

Thirty-four patients with symptomatic pseudarthrosis of anterior cervical fusion were treated. There were 16 men and 18 women. Eighteen patients had pseudarthrosis at 1 level; 14 at 2 levels; and 2 at 3 levels, with C5-6 and C6-7 levels most commonly involved. Anterior repair of pseudarthrosis was done in 17 patients, which resulted in 76% radiologic fusion. Of 17 patients repaired posteriorly, 94% achieved radiologic fusion. Average follow-up was 60 months, with a minimum of 24 months. "Excellent" or "Good" results were achieved in 59% of anterior repair and 88% of posterior fusion group. This study demonstrates that posterior cervical fusion is the more effective method for repairing symptomatic pseudarthrosis of anterior cervical fusion.

Bone Transplantation↗

PubMed1997

Revision of failed lumbar fusions. A comparison of anterior autograft and allograft.

STUDY DESIGN: The radiographic and clinical results of two different anterior structural grafts were compared in 38 patients who had combined anterior-posterior revision surgery for failed lumbar fusion. OBJECTIVES: Failed lumbar fusion surgery, such as pseudarthrosis or flatback deformity, may result in disabling pain. The optimum revision technique has yet to be defined. The authors of the current study sought to determine which of two different types of anterior graft yields the best results. SUMMARY OF BACKGROUND DATA: Posterior procedures for revision of a failed lumbar fusion have not yielded reliably successful results. A combined anterior-posterior approach may be effective in restoring sagittal balance and enhancing fusion rates. Recent studies have shown femoral ring allografts to be effective in lumbar fusion revision, but no studies have compared these with other types of structural grafts. METHODS: Thirty-eight patients with pseudarthrosis were treated with combined anterior-posterior lumbar spine fusion using either femoral ring allografts (26 patients) or tricortical iliac autografts (12 patients). Radiographic follow-up examination and retrospective patient self-assessment questionnaires were used to evaluate outcomes. Results were assessed by independent reviewers after a mean follow-up period of 35 months. RESULTS: Radiographic follow-up examination revealed acceptably low pseudarthrosis rates for structural autografts (0%) and allografts (6%). The questionnaires revealed significant improvement in pain for both groups. Allograft patients showed greater improvement in function, less pain medication usage, and higher overall success rates (83%) than autograft patients (64%). CONCLUSIONS: Femoral ring allografts are as effective, clinically and radiographically, as tricortical iliac autografts when used as an anterior structural element in revision lumbar spine fusion in patients who have undergone multiple surgical procedures for pseudarthrosis or flatback deformity. The slightly greater improvement for the allograft group needs to be confirmed in a larger study.

Adult↗

PubMed1999

Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches.

STUDY DESIGN: An analysis of consecutive pediatric patients treated surgically for high-grade spondylolisthesis by one of three surgical procedures with emphasis on complications and functional outcomes. OBJECTIVE: Complications, radiographic results and patient-assessed function, pain, and satisfaction were assessed among three surgical procedures. SUMMARY OF BACKGROUND DATA: The existing literature is in disagreement about whether it is better to fuse without instrumented reduction or to use instrumentation and reduce high-grade dysplastic spondylolisthesis. METHODS: Thirty-two patients had 37 surgical procedures for Meyerding Grade 3 or 4 isthmic dysplastic spondylolisthesis. Eleven patients were treated with an in situ L4-sacrum posterior fusion without decompression (Group 1), 7 had posterior decompression with posterior instrumentation and posterior fusion (Group 2), and 19 patients had reduction and a circumferential fusion procedure (Group 3). All patients had new radiographs taken at time of follow-up (average, 3.1 years; range, 2 years-10 years, 1 month) and completed a functional outcome questionnaire. RESULTS: The incidence of pseudarthrosis was 45% (5 of 11) in Group 1, 29% (2 of 7) in Group 2, and 0% (0 of 19) in Group 3. All seven who had pseudarthrosis had small L5 transverse process surface area (< 2 cm2; P = 0.004). Only one patient had a neurologic deficit (unilateral extensor hallucis longus weakness) at time of follow-up. There were no significant differences among the groups in function, pain, and satisfaction in patients in whom solid fusion was obtained, but the scores were highest in Group 3. CONCLUSIONS: In situ fusion surgery in patients with high-grade spondylolisthesis with small L5 transverse processes (surface area, < 2 cm2) results in a high rate of pseudarthrosis. Circumferential procedures result in the highest rate of fusion and are effective in achieving fusion in those patients with established pseudarthrosis. The use of long (> 60 mm) iliac screws bilaterally (n = 21) in addition to bicortical sacral screws (four-point sacral-pelvis fixation) along with anterior column fusion reduces the risk of instrumentation failure in a decompression and reduction procedure. Outcomes of function, pain, and satisfaction are excellent in those in whom fusion is achieved. The risks in circumferential fusion-reduction procedures are acceptable.

Adolescent↗

PubMed2001

Extension of fusions to the pelvis in idiopathic scoliosis.

STUDY DESIGN: Retrospective study of patients after extension of previous scoliosis fusions to the pelvis. OBJECTIVE: To determine whether modern instrumentation and surgical techniques provide for increased fusion rates with fewer complications. SUMMARY OF BACKGROUND DATA: Traditionally, long fusions to the pelvis in adults with idiopathic scoliosis have resulted in high complication rates, including pseudarthrosis. METHODS: The hospital and clinic charts of 41 patients (40 female, 1 male) were reviewed 41 months (range: 24-116) after surgery for extension to the pelvis of previous scoliosis fusions. Thirty-nine of 41 had a combined anteroposterior fusion extension; two had posterior extension only. In 37 of 41 patients, Cotrel-Dubousset (CD) instrumentation was used; in two, Isola (Acromed Corp., Cleveland, OH), in one, TSRH; (Sofamor-Danek, Memphis, TN), and in one, Synergy (Cross Medical Products, Columbus, OH). Parameters analyzed were fusion rate, sagittal and coronal balance, lumbar lordosis, length of fusion extension, and distal fixation method. RESULTS: Complications were seen in 30 of 41 patients. The pseudarthrosis rate was 37% (15/41) and was significantly related to the method of distal posterior fixation. With sacral fixation only, the rate was 53% (8/15), with iliac fixation only 42% (3/7), and with both iliac and sacral fixation 21% (4/19; P < 0.05). This was not correlated with fusion rate, and the length of fusion extension did not affect the pseudarthrosis rate or sagittal balance. CONCLUSION: When fixed to the ilium and sacrum, modern instrumentation appears capable of maintaining sagittal balance with lower rates of pseudarthrosis when previous scoliosis fusions are extended to the pelvis. The complication rate remains significant.

Adult↗

PubMed2001

Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective clinical cases series. OBJECTIVES: To prospectively evaluate outcomes and critically review radiographic results and complications associated with single solid rod anterior spinal fusions in adolescent idiopathic scoliosis with 2-year minimum follow-up (range, 2-6 years). METHODS: Ninety consecutive patients at a single institution with thoracic (n = 43) or thoracolumbar/lumbar (n = 47) adolescent idiopathic scoliosis were treated by one of two surgeons with a similar anterior surgical technique using rib autograft, intradiscal structural (Harms) cages placed below T12, and anterior single solid rod convex compressive instrumentation. The patients were evaluated prospectively with the Scoliosis Research Society outcome instrument and upright radiographs before surgery and minimum 2-year follow-up. RESULTS (RADIOGRAPHIC): The average coronal correction of thoracic curves was from 55 degrees to 29 degrees (47%). The average correction of thoracolumbar/lumbar curves was from 50 degrees to 15 degrees (70%). In the sagittal plane, kyphosis was improved in thoracic fusions from 23 degrees to 30 degrees (T5-T12) and lordosis maintained in thoracolumbar/lumbar fusions at -58 degrees (T12-sacrum). Five patients (5.5%) developed a pseudarthrosis, four with implant failure. Three of five required a posterior fusion for a reoperation rate of 3.3%. The fourth and fifth patients were asymptomatic and appeared fused at the 2-year follow-up, with minimal loss of correction. Common risk factors for pseudarthrosis were smoking (4 of 5), weight >70 kg (4 of 5), and for thoracic pseudarthrosis, hyperkyphosis >40 degrees T5-T12 (2 of 3). RESULTS (CLINICAL OUTCOME): Scoliosis Research Society domain average scores were improved for function, pain, and self-image (P < 0.01). With the Scoliosis Research Society satisfaction domain, 88% responded that they were satisfied with their results and 89% would undergo the same treatment again. Four of five patients with pseudarthrosis did not have statistically significant lower final Scoliosis Research Society scores than those with solid fusions (93 vs. 97, P = 0.18). CONCLUSION: Anterior instrumented fusions for adolescent idiopathic scoliosis using a single solid rod had good radiographic and clinical outcomes. Consideration should be given to alternate techniques in larger adolescents (>70 kg) with thoracic hyperkyphosis (>40 degrees ), and smoking should be avoided. Poor radiographic outcomes did not correlate with final Scoliosis Research Society scores.

Adolescent↗

PubMed2001

Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws.

STUDY DESIGN: An analysis of lumbosacral fusions for high-grade spondylolisthesis fusions with reduction and long fusions to the sacrum in ambulatory adults. OBJECTIVE: To assess the clinical and radiographic results of lumbosacral fusions using bilateral S1 and iliac screws. SUMMARY OF BACKGROUND DATA: S1 screws often fail with lumbosacral fusions, whereas L5-S1 pseudarthrosis is common in patients with deformity. MATERIALS AND METHODS: A total of 81 patients (38 revision, 43 primary) with minimum 2-year follow-up (average, 4.2 years; range, 2.0-7.1 years) underwent L5-S1 fusion using S1 and iliac screws (158 screws). Forty-nine of 81 constructs (61%) included an anterior load-sharing/fixation device. Group 1 included isthmic spondylolisthesis (n = 42), whereas Group 2 included long fusions (> or =3 levels) to the sacrum (n = 39). In Group 2, 15 patients (Group 2A) were fused from L1, L2, or L3 to the sacrum (3-5 levels, average 3.3 levels) and 24 patients (Group 2B) were fused from the thoracic spine to the sacrum (6-17 levels, average 11.5 levels). Twelve patients had pseudarthrosis at L5-S1. A patient questionnaire was completed. RESULTS: A total of 36 of the 38 revision patients had previous iliac crest harvesting, yet iliac screws were placed in 34 of 36 patients. Overall, 78 of 80 patients had iliac crest harvesting (one not attempted). None had loss of screw fixation or iliac crest fracture after harvesting. Four of the 81 patients (4.9%) had pseudarthrosis at L5-S1 after reconstruction. This included solid fusion in 10 of 12 patients presenting with L5-S1 pseudarthrosis. Fourteen percent of patients experienced some discomfort over the iliac screws; however, only one patient required screw removal. CONCLUSIONS: Bilateral iliac screws coupled with bilateral S1 screws provide excellent distal fixation for lumbosacral fusions with a high fusion rate (95.1%) in high-grade spondylolisthesis and long fusions to the sacrum. Previous iliac crest harvesting does not prevent ipsilateral screw placement (34 of 36 patients) or additional iliac harvesting (78 of 80 patients).

Adolescent↗

PubMed1992

Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease.

Ten adolescent patients with Charcot-Marie-Tooth disease (12 feet) were evaluated an average of 7 years, 7 months following triple arthrodesis (TA) for the treatment of cavovarus deformity. The TA was the primary or index bone procedure. At follow-up, five feet were plantigrade, asymptomatic, and radiographically fused at all three joints. Three feet were plantigrade and asymptomatic, but two had talonavicular pseudarthrosis and one had calcaneocuboid pseudarthrosis. Three feet were radiographically fused at all three joints, but in nonplantigrade positions and symptomatic. One foot required a revision TA. In general, TA offers adolescent Charcot-Marie-Tooth patients a stable plantigrade foot in the face of a progressive disorder. The residual deformity, revision, and pseudarthrosis rates are similar to those for adults. Postoperative pain was related to a nonplantigrade foot and not to the presence of pseudarthrosis. It is not known whether a nonplantigrade foot was a result of incomplete surgical correction or recurrent deformity due to progressive muscle imbalance.

Adolescent↗

PubMed1997

Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study.

Forty-two neurologically intact adults in whom non-operative treatment of grade-I or grade-II isthmic spondylolisthesis of the most caudad lumbar segment had failed were entered into a prospective study of the results of operative treatment. Twenty patients who smoked were managed with a posterolateral arthrodesis with instrumentation (transpedicular fixation), and twenty-two patients who did not smoke were managed with a posterolateral arthrodesis without instrumentation. Of the patients who were managed with instrumentation, eight were randomized to treatment with a decompressive laminectomy and twelve, to treatment without it; in the group that was managed without instrumentation, the distribution was ten and twelve patients, respectively. The patients were followed clinically for a mean of 4.5 years (range, 3.5 to six years). Of the eighteen patients who had been managed with decompression, four had a pseudarthrosis and six had an unsatisfactory result compared with none and one of the twenty-four who had been managed without decompression (p = 0.02 and p = 0.01, respectively). In the group of twenty patients (smokers) who had been managed with instrumentation, none of the twelve managed without decompression had a pseudarthrosis compared with one of the eight managed with decompression (p = 0.2). In the group of twenty-two patients (non-smokers) who had been managed without instrumentation, none of the twelve managed without decompression had a pseudarthrosis compared with three of the ten managed with decompression (p = 0.04). In the group managed with instrumentation, two of the eight who had had decompression had an unsatisfactory result compared with none of the twelve who had not had decompression. In the group managed without instrumentation, four of the ten who had had decompression had an unsatisfactory result compared with one of the twelve who had not had decompression. The addition of decompression to arthrodesis, performed with or without instrumentation, for the treatment of low-grade isthmic spondylolisthesis in patients who do not have a serious neurological deficit does not appear to improve the result and may significantly increase the rates of pseudarthrosis and unsatisfactory results.

Adult↗

PubMed2006

Prospective assessment of cervical fusion status: plain radiographs versus CT-scan.

The purpose of this prospective study was to compare the pseudarthrosis rate after anterior cervical fusion, estimated either with static and dynamic plain radiographs or with two-dimensional CT-scans. There is a plethora of radiographic tools and criteria used to determine pseudarthrosis after cervical spine fusion. However, it is not known to which extent these tools correlate with each other. Forty-seven adult patients were enrolled in this study, about one year after surgery. Four independent blinded observers evaluated the roentgenological data. CT assessment led to higher pseudarthrosis rates than plain radiographs: 13 to 31% according to CT; 2 to 16% according to plain radiographs. The difference averaged 11%. Consistency between reviewers was higher with CT (average agreement: 89%; range 82%-96%) than with plain radiographs (average agreement: 81%; range: 76% to 87%). The need to accurately document pseudarthrosis is critical as it helps direct the postoperative management of the patient. The present study stresses the value of computed tomography. However, surgical exploration continues to be the gold standard.

Adult↗

PubMed1993

[Results of allogeneic bone transplants in spondylodesis of the spine].

The use of allogeneic bone bank bone was evaluated in 67 patients, operated for disorders of the spine. In 26 patients with paralytic scoliosis a pseudarthrosis developed three times and there was one infection. In 28 patients with other causes of scoliosis there were also three cases with pseudarthrosis. In the group of posterolateral arthrodesis of the lumbar spine we saw four patients out of 13 with pseudarthrosis. The results are in accordance with the literature. The use of allogeneic bone in scoliosis surgery is justified in view of the acceptable pseudarthrosis rate and the low incidence of infection. In the lumbar spine group, however, the use of bone bank bone gives less satisfactory results. The use of autologous bone is recommended for this group. There were no signs of transmission of infectious diseases in the total group of patients.

Adolescent↗

PubMed2004

Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion.

In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. Male gender, one-level surgery and CP treatment were significant predictors of fusion and explained 14% of the variability of fusion status at follow-up. Number of levels operated on, however, did not influence the clinical outcome. Fifty-two per cent of the women and 17% of the men in the CIFC group, and 25% of the women and 8% of the men in the CP group, had pseudarthrosis. Although patients with a healed fusion had significantly less pain intensity than patients with pseudarthrosis, radiological variables explained only 4% of the variability of pain at follow-up. Apart from a significant correlation between preoperative kyphosis and neck disability index at follow-up, no significant correlation between either postoperative kyphosis or preoperative or postoperative disc height and clinical outcome was found. Neither degree of segmental kyphosis nor disc height was different between patients with healed fusion and pseudarthrosis. One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.

Adult↗