Manuel Fernandes Marques1, Vincent Fiere2, Ibrahim Obeid3,4, Yann-Philippe Charles5, Khaled El-Youssef6, Abi Lahoud7, Joe Faddoul7, Emmanuelle Ferrero8, Guillaume Riouallon9, Clément Silvestre10, Jean-Charles Le Huec11, David Kieser12, Louis Boissiere3,4. 1. Serviço de Ortopedia, Unidade Local de Saúde do Litoral Alentejano, Santiago do Cacem, Portugal. 2. Spinal Unit, Santy Orhopaedic Center and Mermoz Hospital Ramsay GDS, Lyon, France. 3. Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France. 4. Clinique du Dos-Bordeaux and ELSAN Polyclinique Jean Villar, 33520, Bruges, France. 5. Department of Spine Surgery, Strasbourg University Hospital, 1, place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France. 6. Chirurgie Orthopedique et Traumatologique - Clocheville, Centre Hospitalier Regional Universitaire de Tours, Tours, France. 7. Neurosurgery Department, Sainte-Anne Hospital, Paris, France. 8. Department of Orthopaedic Surgery, Hôpital Georges Pompidou, 75015, Paris, France. 9. Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, 75014, Paris, France. 10. CMR Des Massues, 92 Rue Dr Edmond Locard, 69005, Lyon, France. 11. Orthopédie-Traumatologie Department, Polyclinique Bordeaux Nord Aquitaine, 33000, Bordeaux, France. 12. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, Christchurch, 8011, New Zealand. kieserdavid@gmail.com.
Abstract
PURPOSE: Highlight risk factors for pseudarthrosis in long-segment spinal fusions, collect the approaches carried to address this complication. METHODS: Patients with ASD and fusion of ≥ 4 levels with minimum follow-up (FU) of ≥ 2 years were included. Full-body X-rays were done preoperatively, < 3 months and ≥ 2 years. Oswestry disability index (ODI), Scoliosis Research Society-22 and SF36 assessed pre- and postoperatively. The relationship between demographic, surgical and radiological variables with the development of pseudarthrosis was evaluated. RESULTS: Out of 524 patients included, 65 patients (12.4%) developed pseudarthrosis and 53 underwent revision surgery. Notably, 88% of pseudarthrosis cases are associated with fusion length (OR = 1.17, 95% CI = 1.05-1.292, p = 0.004), osteotomy requirement (OR = 0.28, 95% CI = 0.09-0.85, p = 0.025), pelvic fixation (OR = 0.34, 95% CI = 0.13-0.88, p = 0.026) and combined approaches (OR = 3.29, 95% CI = 1.09-9.91, p = 0.034). Sagittal alignment is not related to the rate of pseudarthrosis. Health related and quality of life scores were comparable at last FU between patients revised for pseudarthrosis and those that didn't require revision surgery (ODI = 28% no revision and 30% revision group). CONCLUSIONS: Pseudarthrosis is not related to malalignment, but with the surgical techniques employed for its treatment. Anterior approaches with anterior support decrease the rate by 30%, while long fusions, osteotomies and pelvic fixation increase its rate.
PURPOSE: Highlight risk factors for pseudarthrosis in long-segment spinal fusions, collect the approaches carried to address this complication. METHODS:Patients with ASD and fusion of ≥ 4 levels with minimum follow-up (FU) of ≥ 2 years were included. Full-body X-rays were done preoperatively, < 3 months and ≥ 2 years. Oswestry disability index (ODI), Scoliosis Research Society-22 and SF36 assessed pre- and postoperatively. The relationship between demographic, surgical and radiological variables with the development of pseudarthrosis was evaluated. RESULTS: Out of 524 patients included, 65 patients (12.4%) developed pseudarthrosis and 53 underwent revision surgery. Notably, 88% of pseudarthrosis cases are associated with fusion length (OR = 1.17, 95% CI = 1.05-1.292, p = 0.004), osteotomy requirement (OR = 0.28, 95% CI = 0.09-0.85, p = 0.025), pelvic fixation (OR = 0.34, 95% CI = 0.13-0.88, p = 0.026) and combined approaches (OR = 3.29, 95% CI = 1.09-9.91, p = 0.034). Sagittal alignment is not related to the rate of pseudarthrosis. Health related and quality of life scores were comparable at last FU between patients revised for pseudarthrosis and those that didn't require revision surgery (ODI = 28% no revision and 30% revision group). CONCLUSIONS:Pseudarthrosis is not related to malalignment, but with the surgical techniques employed for its treatment. Anterior approaches with anterior support decrease the rate by 30%, while long fusions, osteotomies and pelvic fixation increase its rate.
Authors: Alan H Daniels; J Mason DePasse; Wesley Durand; D Kojo Hamilton; Peter Passias; Han Jo Kim; Themistocles Protopsaltis; Daniel B C Reid; Virginie LaFage; Justin S Smith; Christopher Shaffrey; Munish Gupta; Eric Klineberg; Frank Schwab; Doug Burton; Shay Bess; Christopher Ames; Robert A Hart Journal: World Neurosurg Date: 2018-06-19 Impact factor: 2.104
Authors: Justin S Smith; Ellen Shaffrey; Eric Klineberg; Christopher I Shaffrey; Virginie Lafage; Frank J Schwab; Themistocles Protopsaltis; Justin K Scheer; Gregory M Mundis; Kai-Ming G Fu; Munish C Gupta; Richard Hostin; Vedat Deviren; Khaled Kebaish; Robert Hart; Douglas C Burton; Breton Line; Shay Bess; Christopher P Ames Journal: J Neurosurg Spine Date: 2014-10-17
Authors: Leah Y Carreon; Kelly R Bratcher; Chelsea E Canan; Lauren O Burke; Mladen Djurasovic; Steven D Glassman Journal: J Neurosurg Spine Date: 2012-11-16
Authors: Justin S Smith; Christopher I Shaffrey; Christopher P Ames; Jason Demakakos; Kai-Ming G Fu; Sassan Keshavarzi; Carol M Y Li; Vedat Deviren; Frank J Schwab; Virginie Lafage; Shay Bess Journal: Neurosurgery Date: 2012-10 Impact factor: 4.654
Authors: Caglar Yilgor; Nuray Sogunmez; Louis Boissiere; Yasemin Yavuz; Ibrahim Obeid; Frank Kleinstück; Francisco Javier Sánchez Pérez-Grueso; Emre Acaroglu; Sleiman Haddad; Anne F Mannion; Ferran Pellise; Ahmet Alanay Journal: J Bone Joint Surg Am Date: 2017-10-04 Impact factor: 5.284
Authors: Nathan E How; John T Street; Marcel F Dvorak; Charles G Fisher; Brian K Kwon; Scott Paquette; Justin S Smith; Christopher I Shaffrey; Tamir Ailon Journal: Neurosurg Rev Date: 2018-02-06 Impact factor: 3.042
Authors: Marloes J M Peters; Carolien H G Bastiaenen; Boudewijn T Brans; René E Weijers; Paul C Willems Journal: Skeletal Radiol Date: 2019-02-23 Impact factor: 2.199