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CONDITIONS

Pseudarthrosis

Pseudarthrosis, also known as a nonunion, is a complication that can occur after a spinal fusion surgery when the process of fusing two bones fails. During spinal fusion surgery, the two bones are roughened up and a bone graft is placed between them. The body then forms new bones to connect and fuse the two bones together. However, sometimes the new bone fails to join the two spine bones together, resulting in a nonunion. The lack of bone formation, the fusion, creates ongoing stress on the metal instrumentation. Over time the metal can acquire sufficient fatigue to break or come loose. Broken or loose instrumentation is generally a hallmark of a nonunion.

Several factors can increase the risk of a nonunion, including nicotine use, movement at the fusion site, and other medical issues. Nicotine use is particularly significant and can be addressed to reduce the risk of pseudarthrosis. Osteoporosis, or poor bone density, is another factor that can be optimized with newer medication and supplements to reduce the risk of nonunion.

Symptoms & Diagnosis

Symptoms of pseudarthrosis may become apparent weeks, months, or even years after the initial fusion surgery. In some cases, they may not be noticeable until the fusion has had time to fail or if the stress on the fused area increases over time. These symptoms may include:

  • Pain at the site of the fusion that persists or returns after an initial period of relief
  • A feeling of instability or abnormal movement in the affected area
  • Recurrence of symptoms that the surgery was intended to alleviate
  • Broken or loose instrumentation
  • Changes in spinal alignment
  • Recurrence of spinal deformity

Symptoms may also extend to the extremities if the nonunion contributes to nerve irritation, which is a common occurrence. Even in a situation where there is no stenosis, the abnormal motion and local inflammation may contribute to nerve irritation and symptoms. To diagnose pseudarthrosis, an X-ray or MRI will be done to provide a detailed image of the spine and spinal cord; however, a CT scan is the most helpful in the determination of a nonunion and loose or broken instrumentation.

Treatment

Surgical intervention is typically needed for pseuarthrosis. Often, the spinal implants put in place during the fusion surgery break or come loose and they need to be replaced. As well, any deformity or malalignment that is present needs to be addressed. Lastly, preparation of the bony surfaces for fusion and bone grafting are critical to encourage fusion bone growth.

Surgical intervention
  • Revision surgery If Dr. Avramis recommends a second spinal fusion, revision surgery may be done to replace loose implants or devices or use stronger implants of different techniques to promote the fusion. Depending on the individual, he may follow a different approach than what was initially performed.
Before a spinal fusion, efforts are made to optimize a patient’s overall medical condition, which can improve the chances of success with the surgery. Surgical advances in the use of spinal instrumentation, bone graft substitutes, and more have helped spine surgeons decrease the risk of pseudarthrosis after surgery. However, pseudarthrosis can still occur as a complication of spinal fusion, and Dr. Avramis has helped many patients find success with subsequent procedures.
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Our team at Avramis Spine & Scoliosis is here to help. To request an appointment or for any other inquiries, please fill out the form.

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Contact

Our team at Avramis Spine & Scoliosis is here to help. To request an appointment or for any other inquiries, please fill out the form.