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Lawrence G Lenke - One of the best experts on this subject based on the ideXlab platform.
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Minimum five-year follow-up of posterior-only pedicle screw constructs for thoracic and thoracolumbar kyphosis
European Spine Journal, 2019Co-Authors: Chang Ju Hwang, Kathy M. Blanke, Brenda A Sides, Michael P Kelly, Lawrence G Lenke, Stuart HershmanAbstract:Study designRetrospective cohort study.ObjectiveTo review/report 5-year follow-up data on patients diagnosed with thoracic and thoracolumbar kyphosis (TK/TLK) treated with posterior-only spinal fusion.Summary of background dataTK/TLK was initially treated with combined anterior/posterior spinal fusion, evolving into widespread treatment with posterior-only spinal fusion.MethodsForty-three patients who underwent a posterior-only spinal fusion for a primary diagnosis of TK/TLK from 1999 to 2009 with > 5-year follow-up were identified. Preoperative/postoperative/final follow-up measurements were recorded from full-length standing radiographs. Prospectively collected outcome scores were reviewed for the same time points, and charts were examined for complications.ResultsPatient age averaged 33 years (range 13–77), and follow-up averaged 5.6 years (range 5–12.2). Diagnoses included Scheuermann’s disease ( N = 15, 35%), idiopathic ( N = 10, 23%), Pseudarthrosis ( N = 6, 14%), iatrogenic ( N = 4, 9%), degenerative ( N = 3, 7%), post-traumatic ( N = 3, 7%), and congenital kyphosis ( N = 2, 5%). Average correction of 44.3° (46%; 92.8° preoperatively vs 48.5° postoperatively) was achieved through posterior-only surgery. Loss of correction averaged only 1° in the instrumented segments at final follow-up. Eleven patients had a complication; proximal junctional kyphosis was the most common ( N = 3, 7%). One patient lost intraoperative monitoring and one had temporary neurological deterioration postoperatively, but there was no permanent deficit. No pseudarthroses occurred. ODI scores improved 17.2 points on average ( p = 0.01). SRS scores improved in all domains (average 0.79, p
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risk factors for and assessment of symptomatic Pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity
Spine, 2014Co-Authors: Douglas D Dickson, Lawrence G Lenke, Keith H Bridwell, Linda A KoesterAbstract:STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To assess the prevalence, risk factors, and clinical outcomes for Pseudarthrosis after a lumbar pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA: There exists no large series that examines Pseudarthrosis rates of PSOs. METHODS: Data of 171 consecutive patients with adult deformity who underwent a lumbar PSO by 2 surgeons at a single institution with a minimum 2-year follow-up were analyzed. Pseudarthrosis diagnosed through sagittal malalignment and instrumentation failure noted on radiograph was confirmed intraoperatively. RESULTS: Eighteen (10.5%) of 171 patients developed Pseudarthrosis after a PSO. Eleven of the 18 patients (6.4% of all patients, 61.1% of the 18 patients with Pseudarthrosis) had Pseudarthrosis at the PSO site, L3 being the most common; other locations included the lumbosacral junction (4/18), thoracolumbar junction (2/18), and upper thoracic spine (1/18). Preoperative Pseudarthrosis level was a predictor of the postoperative level of Pseudarthrosis (93%). Fifteen of the 18 patients (83%) had no interbody fusion directly above or below the PSO site, 16 (88%) had a history of Pseudarthrosis at the time of PSO surgery and 2 of 3 patients who had prior radiation to the lumbar region developed Pseudarthrosis. Most pseudarthroses occurred within the first 2 years (n = 13/18), between 2 and 5 years (n = 3/18), and more than 5 years (n = 2/18) postoperatively. Prior Pseudarthrosis (P < 0.0001), Pseudarthrosis at the PSO site (P < 0.0001), prior decompression in the lumbar region (P = 0.0037), prior radiation to the lumbar region (P < 0.0001), and presence of inflammatory/neurological disorders (P < 0.0036) were identified as risk factors. All 18 patients with pseudarthroses required revision surgery (posterior-only surgery, n = 12; anteroposterior surgery, n = 6) due to loss of sagittal alignment and pain. The mean pre-revision Scoliosis Research Society score was 85, post-revision score was 95 (P = 0.0166), and the mean pre-revision Oswestry Disability Index score was 42.5, post-revision score was 34.5 (P = 0.0203). CONCLUSION: The overall prevalence of Pseudarthrosis was 10.5% of which 61% occurred at the actual PSO site and Scoliosis Research Society and Oswestry Disability Index scores improved significantly after Pseudarthrosis repair. LEVEL OF EVIDENCE: 4.
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Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum prevalence and risk factor analysis of 144 cases
Spine, 2006Co-Authors: Keith H Bridwell, Lawrence G Lenke, Seungchul Rhim, Gene ChehAbstract:Study Design. Retrospective study. Objective. To analyze the incidence of and risk factors for Pseudarthrosis in long adult spinal instrumentation and fusion to S1. of Background Data. Few studies on Pseudarthrosis in long adult spinal instrumentation and fusion to S1 exist. Methods. A clinical and radiographic assessment of 144 adult patients with spinal deformity (average age 52.0 years; range 21.1-77.6) who underwent long (5-17 vertebrae, average 11.9) spinal instrumentation and fusion to the sacrum at a single institution between 1985 and 2002, with a minimum 2-year follow-up (average 3.9; range 2-14) was performed. Results. Of 144 patients, 34 (24%) had pseudarthroses. There were 17 patients who had pseudarthroses at T10-L2 and 15 at L5-S1. A total of 24 patients (71%) presented with multiple levels involved (2-6). Pseudarthrosis was most commonly detected within 4 years postoperatively (31 patients; 94%). Factors that statistically increased the risk of Pseudarthrosis were: thoracolumbar kyphosis (T10-L2 ≥20° vs. <20°, P < 0.0001); osteoarthritis of the hip joint (P = 0.002); thoracoabdominal approach (vs. paramedian approach, P = 0.009); positive sagittal balance ≥5 cm at 8 weeks postoperatively (vs. ≤5cm, P= 0.012); age at surgery older than 55 years (vs. 55 years or younger, P = 0.019); and incomplete sacropelvic fixation (vs. complete sacropelvic fixation, P = 0.020). Fusion from upper thoracic spine (T2-T5) did not statistically increase the Pseudarthrosis rate compared to lower thoracic spine (T9-T12) (P = 0.20). Patients with Pseudarthrosis had significantly lower Scoliosis Research Society 24 outcome scores (average score 71/120) than those without (average score 90/120; P < 0.0001) at ultimate follow-up. Conclusion. The overall prevalence of Pseudarthrosis following long adult spinal deformity instrumentation and fusion to S1 was 24%. Thoracolumbar kyphosis, osteoarthritis of the hip joint, thoracoabdominal approach (vs. paramedian approach), positive sagittal balance ≥5 cm at 8 weeks postoperatively, older age at surgery (older than 55 years), and incomplete sacropelvic fixation significantly increased the risks of Pseudarthrosis to an extent that was statistically significant. Scoliosis Research Society 24 outcomes scores at ultimate follow-up were adversely affected when Pseudarthrosis developed.
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Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Keith H Bridwell, Lawrence G Lenke, Charles C Edwards, Anthony RinellaAbstract:Background: There have been few detailed reports concerning Pseudarthrosis following spinal instrumentation and arthrodesis in adults with spinal deformity since the introduction of modern segmental fixation techniques. The purposes of this study were to analyze the prevalence, risk factors, and outcome scores on the Scoliosis Research Society Instrument-24 associated with Pseudarthrosis following instrumentation and arthrodesis for the treatment of spinal deformity in adults. Methods: A clinical and radiographic assessment of 232 adults with spinal deformity who were treated surgically at a single institution was conducted. The average age of the patients was 40.8 years, and the operation was a primary procedure in 150 patients and a revision procedure in eighty-two patients. All patients who underwent a long (four vertebrae or more) spinal instrumentation and arthrodesis with a minimum follow-up of two years were included in the analysis. Clinical outcomes were assessed with the Scoliosis Research Society questionnaire. Results: Forty patients had a Pseudarthrosis. Factors that were found to be significantly associated with Pseudarthrosis were preoperative thoracolumbar kyphosis of >20° (p < 0.0001), an age of more than fifty-five years (p = 0.001), arthrodesis to S1 compared with arthrodesis to L5 or a cephalad level (p = 0.002), and arthrodesis of more than twelve vertebrae (p = 0.037). Patients with a Pseudarthrosis had lower total outcome scores on the Scoliosis Research Society questionnaire, on the average, than those without a Pseudarthrosis (p = 0.001). Conclusions: The prevalence of Pseudarthrosis following long arthrodesis with use of modern segmental spinal instrumentation for the treatment of spinal deformity in adults was 17%, and the clinical outcome in these patients can be negatively affected by the Pseudarthrosis. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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Pseudarthrosis in primary fusions for adult idiopathic scoliosis incidence risk factors and outcome analysis
Spine, 2005Co-Authors: Keith H Bridwell, Lawrence G Lenke, Anthony Rinella, Charles EdwardAbstract:STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the incidence, characteristics, risk factors, and Scoliosis Research Society Instrument-24 (SRS-24) outcome scores of Pseudarthrosis in adult idiopathic scoliosis primary fusions. SUMMARY OF BACKGROUND DATA: The healing of spinal fusion is complex and difficult to study in a clinical setting. There are no detailed reports on Pseudarthrosis in primary fusion for adult idiopathic scoliosis since the introduction of "modern" segmental fixation techniques. METHODS: A retrospective chart and radiographic review of 96 patients (average age 42.2 years; range 18.2-62.9 years) with adult idiopathic scoliosis undergoing first time (primary) spinal instrumentation and fusion with a minimum 2-year follow-up (average 5.9 years; range 2-16.8 years) treated at a single institution between 1985 and 2001 were analyzed. RESULTS: Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with Pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with Pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with Pseudarthrosis (P = 0.03). Smoking history and comorbidity did not increase the Pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (> or =70 degrees) and a greater thoracic kyphosis (T5-T12 >40 degrees) did not correlate with a higher Pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 > or =20 degrees) correlated with a significantly higher Pseudarthrosis rate (P 55 years), longer fusion (>12 vertebrae), and those with thoracolumbar kyphosis (> or =20 degrees) demonstrated increased risk for Pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the Pseudarthrosis.
Keith H Bridwell - One of the best experts on this subject based on the ideXlab platform.
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risk factors for and assessment of symptomatic Pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity
Spine, 2014Co-Authors: Douglas D Dickson, Lawrence G Lenke, Keith H Bridwell, Linda A KoesterAbstract:STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To assess the prevalence, risk factors, and clinical outcomes for Pseudarthrosis after a lumbar pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA: There exists no large series that examines Pseudarthrosis rates of PSOs. METHODS: Data of 171 consecutive patients with adult deformity who underwent a lumbar PSO by 2 surgeons at a single institution with a minimum 2-year follow-up were analyzed. Pseudarthrosis diagnosed through sagittal malalignment and instrumentation failure noted on radiograph was confirmed intraoperatively. RESULTS: Eighteen (10.5%) of 171 patients developed Pseudarthrosis after a PSO. Eleven of the 18 patients (6.4% of all patients, 61.1% of the 18 patients with Pseudarthrosis) had Pseudarthrosis at the PSO site, L3 being the most common; other locations included the lumbosacral junction (4/18), thoracolumbar junction (2/18), and upper thoracic spine (1/18). Preoperative Pseudarthrosis level was a predictor of the postoperative level of Pseudarthrosis (93%). Fifteen of the 18 patients (83%) had no interbody fusion directly above or below the PSO site, 16 (88%) had a history of Pseudarthrosis at the time of PSO surgery and 2 of 3 patients who had prior radiation to the lumbar region developed Pseudarthrosis. Most pseudarthroses occurred within the first 2 years (n = 13/18), between 2 and 5 years (n = 3/18), and more than 5 years (n = 2/18) postoperatively. Prior Pseudarthrosis (P < 0.0001), Pseudarthrosis at the PSO site (P < 0.0001), prior decompression in the lumbar region (P = 0.0037), prior radiation to the lumbar region (P < 0.0001), and presence of inflammatory/neurological disorders (P < 0.0036) were identified as risk factors. All 18 patients with pseudarthroses required revision surgery (posterior-only surgery, n = 12; anteroposterior surgery, n = 6) due to loss of sagittal alignment and pain. The mean pre-revision Scoliosis Research Society score was 85, post-revision score was 95 (P = 0.0166), and the mean pre-revision Oswestry Disability Index score was 42.5, post-revision score was 34.5 (P = 0.0203). CONCLUSION: The overall prevalence of Pseudarthrosis was 10.5% of which 61% occurred at the actual PSO site and Scoliosis Research Society and Oswestry Disability Index scores improved significantly after Pseudarthrosis repair. LEVEL OF EVIDENCE: 4.
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Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum prevalence and risk factor analysis of 144 cases
Spine, 2006Co-Authors: Keith H Bridwell, Lawrence G Lenke, Seungchul Rhim, Gene ChehAbstract:Study Design. Retrospective study. Objective. To analyze the incidence of and risk factors for Pseudarthrosis in long adult spinal instrumentation and fusion to S1. of Background Data. Few studies on Pseudarthrosis in long adult spinal instrumentation and fusion to S1 exist. Methods. A clinical and radiographic assessment of 144 adult patients with spinal deformity (average age 52.0 years; range 21.1-77.6) who underwent long (5-17 vertebrae, average 11.9) spinal instrumentation and fusion to the sacrum at a single institution between 1985 and 2002, with a minimum 2-year follow-up (average 3.9; range 2-14) was performed. Results. Of 144 patients, 34 (24%) had pseudarthroses. There were 17 patients who had pseudarthroses at T10-L2 and 15 at L5-S1. A total of 24 patients (71%) presented with multiple levels involved (2-6). Pseudarthrosis was most commonly detected within 4 years postoperatively (31 patients; 94%). Factors that statistically increased the risk of Pseudarthrosis were: thoracolumbar kyphosis (T10-L2 ≥20° vs. <20°, P < 0.0001); osteoarthritis of the hip joint (P = 0.002); thoracoabdominal approach (vs. paramedian approach, P = 0.009); positive sagittal balance ≥5 cm at 8 weeks postoperatively (vs. ≤5cm, P= 0.012); age at surgery older than 55 years (vs. 55 years or younger, P = 0.019); and incomplete sacropelvic fixation (vs. complete sacropelvic fixation, P = 0.020). Fusion from upper thoracic spine (T2-T5) did not statistically increase the Pseudarthrosis rate compared to lower thoracic spine (T9-T12) (P = 0.20). Patients with Pseudarthrosis had significantly lower Scoliosis Research Society 24 outcome scores (average score 71/120) than those without (average score 90/120; P < 0.0001) at ultimate follow-up. Conclusion. The overall prevalence of Pseudarthrosis following long adult spinal deformity instrumentation and fusion to S1 was 24%. Thoracolumbar kyphosis, osteoarthritis of the hip joint, thoracoabdominal approach (vs. paramedian approach), positive sagittal balance ≥5 cm at 8 weeks postoperatively, older age at surgery (older than 55 years), and incomplete sacropelvic fixation significantly increased the risks of Pseudarthrosis to an extent that was statistically significant. Scoliosis Research Society 24 outcomes scores at ultimate follow-up were adversely affected when Pseudarthrosis developed.
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Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Keith H Bridwell, Lawrence G Lenke, Charles C Edwards, Anthony RinellaAbstract:Background: There have been few detailed reports concerning Pseudarthrosis following spinal instrumentation and arthrodesis in adults with spinal deformity since the introduction of modern segmental fixation techniques. The purposes of this study were to analyze the prevalence, risk factors, and outcome scores on the Scoliosis Research Society Instrument-24 associated with Pseudarthrosis following instrumentation and arthrodesis for the treatment of spinal deformity in adults. Methods: A clinical and radiographic assessment of 232 adults with spinal deformity who were treated surgically at a single institution was conducted. The average age of the patients was 40.8 years, and the operation was a primary procedure in 150 patients and a revision procedure in eighty-two patients. All patients who underwent a long (four vertebrae or more) spinal instrumentation and arthrodesis with a minimum follow-up of two years were included in the analysis. Clinical outcomes were assessed with the Scoliosis Research Society questionnaire. Results: Forty patients had a Pseudarthrosis. Factors that were found to be significantly associated with Pseudarthrosis were preoperative thoracolumbar kyphosis of >20° (p < 0.0001), an age of more than fifty-five years (p = 0.001), arthrodesis to S1 compared with arthrodesis to L5 or a cephalad level (p = 0.002), and arthrodesis of more than twelve vertebrae (p = 0.037). Patients with a Pseudarthrosis had lower total outcome scores on the Scoliosis Research Society questionnaire, on the average, than those without a Pseudarthrosis (p = 0.001). Conclusions: The prevalence of Pseudarthrosis following long arthrodesis with use of modern segmental spinal instrumentation for the treatment of spinal deformity in adults was 17%, and the clinical outcome in these patients can be negatively affected by the Pseudarthrosis. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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Pseudarthrosis in primary fusions for adult idiopathic scoliosis incidence risk factors and outcome analysis
Spine, 2005Co-Authors: Keith H Bridwell, Lawrence G Lenke, Anthony Rinella, Charles EdwardAbstract:STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the incidence, characteristics, risk factors, and Scoliosis Research Society Instrument-24 (SRS-24) outcome scores of Pseudarthrosis in adult idiopathic scoliosis primary fusions. SUMMARY OF BACKGROUND DATA: The healing of spinal fusion is complex and difficult to study in a clinical setting. There are no detailed reports on Pseudarthrosis in primary fusion for adult idiopathic scoliosis since the introduction of "modern" segmental fixation techniques. METHODS: A retrospective chart and radiographic review of 96 patients (average age 42.2 years; range 18.2-62.9 years) with adult idiopathic scoliosis undergoing first time (primary) spinal instrumentation and fusion with a minimum 2-year follow-up (average 5.9 years; range 2-16.8 years) treated at a single institution between 1985 and 2001 were analyzed. RESULTS: Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with Pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with Pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with Pseudarthrosis (P = 0.03). Smoking history and comorbidity did not increase the Pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (> or =70 degrees) and a greater thoracic kyphosis (T5-T12 >40 degrees) did not correlate with a higher Pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 > or =20 degrees) correlated with a significantly higher Pseudarthrosis rate (P 55 years), longer fusion (>12 vertebrae), and those with thoracolumbar kyphosis (> or =20 degrees) demonstrated increased risk for Pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the Pseudarthrosis.
Sigurd Berven - One of the best experts on this subject based on the ideXlab platform.
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22 subclinical infection as an etiology for Pseudarthrosis in multilevel thoracolumbar spinal fusions
The Spine Journal, 2019Co-Authors: Daniel Beckerman, John Ibrahim, Alexander Tenorio, Alexander A Theologis, Sigurd BervenAbstract:BACKGROUND CONTEXT Pseudarthrosis is a common indication for revision spine operations. Clinical presentations of Pseudarthrosis are heterogeneous. While the majority of patients present with pain, many can be symptomatic. Etiologies of Pseudarthrosis also vary from structural to biologic, including infection. PURPOSE To determine prevalence of subclinical infection and identify risk factors associated with positive intraoperative cultures in revisions for lumbar Pseudarthrosis. STUDY DESIGN/SETTING Single-center retrospective cohort. PATIENT SAMPLE Adults who underwent revision posterior instrumented fusions for lumbar Pseudarthrosis. OUTCOME MEASURES Intraoperative microbiological analysis. METHODS Retrospective review of adults who underwent revision posterior instrumented fusions for lumbar Pseudarthrosis at a single institution. All patients had intraop cultures obtained regardless of clinical suspicion for infection. Patients with overt infection were excluded. Demographic, medical, and surgical data were analyzed for association with positive cultures and instrumentation failure. RESULTS Fifty-one patients (avg age 59.1±13.2 years, female-28, avg # prior operations 3.2±2.8) were included. Seventeen (33.3%) had at least 1 positive intraop culture, and 7 (13.7%) had ≥2 positive intraop cultures. Instrumentation failure was evident in 14 (27.5%) patients. Female gender was associated with decreased odds of having ≥2 positive intraop cultures (OR=0.10, p CONCLUSIONS One third of patients undergoing revision for lumbar Pseudarthrosis had subclinical infection (positive intraoperative culture). As such, intraoperative cultures should ideally be routinely obtained in the revision setting for lumbar Pseudarthrosis and/or instrumentation failure regardless of clinical suspicion for infection. Further studies are necessary to identify risks of subclinical infection leading to Pseudarthrosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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revision surgery for lumbar Pseudarthrosis
The Spine Journal, 2015Co-Authors: Ozgur Dede, Sigurd Berven, Serena S. Hu, Daniel U Thuillier, Murat Pekmezci, Christopher P Ames, Vedat DevirenAbstract:Abstract Background context Revision surgery for Pseudarthrosis after a lumbar spinal fusion has unpredictable functional results. Purpose The aim of this study was to determine the clinical outcomes of revision surgery to fuse the Pseudarthrosis site based on the two most common diagnoses (degenerative disc disease [DDD] vs. spondylolisthesis). Study design Patients who had a revision surgery between 1995 and 2004 for lumbar Pseudarthrosis after short segment lumbar spinal fusion were identified through the institution's Spine Center surgery database. A retrospective chart review of clinical, hospital, and anesthesia records was then performed. Patient sample Sixty-six patients were included in the study (28 patients with DDD and 38 patients with spondylolisthesis). Inclusion criteria were a surgical diagnosis of Pseudarthrosis with a prior fusion of one or two motion segments, minimum 24 months of follow-up, and a diagnosis of either symptomatic DDD or spondylolisthesis as the primary indication for the index fusion surgery. Outcome measures The Oswestry disability index (ODI) and a self-assessment questionnaire were used to evaluate clinical outcomes. Methods A retrospective chart and radiographic review was performed. Statistical analysis was done using Student t test for ODI scores and chi-square test for discrete variables from the outcome questionnaires. Results Follow-up radiographs were available for 64 patients (97%), and a fusion rate of 100% was found in both groups for the radiographs examined. The mean postoperative ODI score was 53.3 (30–84.4) for DDD patients and 37.2 (2.5–76) for the spondylolisthesis group (p Conclusions The clinical outcomes after revision surgery for Pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of Pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
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Treatment of thoracic Pseudarthrosis in the adult: is combined surgery necessary?
Clinical Orthopaedics and Related Research, 2003Co-Authors: Sigurd Berven, Vedat Deviren, Serena S. Hu, David S. BradfordAbstract:: In deformity surgery in adults, Pseudarthrosis remains an important cause of progressive deformity and postoperative pain. Revision surgery for Pseudarthrosis in the lumbar spine is a difficult challenge with failure rates of as much as 50% using posterior surgery alone. Treatment of Pseudarthrosis of the thoracic spine has not been well-described. The purpose of the current study was to review the long-term clinical and radiographic results of posterior-only surgery for the treatment of Pseudarthrosis in the thoracic spine. Using a posterior extension osteotomy through the identified Pseudarthrosis with reinstrumentation and autogenous bone grafting, an improvement of regional sagittal balance was shown and reliable clinical outcomes were obtained. A single-stage posterior revision surgery with extension osteotomies through the regions of Pseudarthrosis coupled with rigid internal fixation and autogenous bone grafting is an effective technique for treatment of Pseudarthrosis of the thoracic spine. This technique improves regional sagittal deformity and leads to reliable arthrodesis. Combined anterior and posterior surgery was not necessary for effective treatment of thoracic Pseudarthrosis in this series.
Jacob M Buchowski - One of the best experts on this subject based on the ideXlab platform.
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construct type and risk factors for Pseudarthrosis at the cervicothoracic junction
Spine, 2015Co-Authors: Justin S Yang, Jacob M Buchowski, Vivek VermaAbstract:STUDY DESIGN: Retrospective cohort. OBJECTIVE: The primary goal is to compare the clinical results of 2 types of constructs commonly used at the cervicothoracic junction: small rods (3.2-mm/3.5-mm rods) or transitional constructs. The secondary goal is to perform a case-control study of risk factors for Pseudarthrosis at the cervicothoracic junction. SUMMARY OF BACKGROUND DATA: Various constructs have been used to stabilize across the cervicothoracic junction; however, no study to date has objectively compared their outcome. Our hypothesis was that both constructs would have similar fusion and complication rates. METHODS: A retrospective review of a prospectively collected database revealed 135 patients with the aforementioned constructs and having followed up with imaging at 6 months, 12 months, and 24 months. Univariate analysis comparing the 2 different construct groups was performed. Multivariate analysis for risk factors of Pseudarthrosis was also performed. RESULTS: There were a total of 10 patients with Pseudarthrosis at 2-year follow-up. There was no difference in Pseudarthrosis rate between the small rods (7%) and transitional constructs (8.6%) (P = 0.99). The overall construct lengths were similar (5.8 levels in small rods, 6.7 levels in transitional construct). Blood loss was higher in transitional constructs (574 ± 69 mL) than in small rods (236 ± 53 mL) (P < 0.001). Transitional constructs also had longer operating times (249 min) than small rods (207 min) (P < 0.03). Overall complication rate was higher in the transitional constructs (P < 0.03). Tobacco use, corpectomy, lack of an anterior construct, and construct length were all risk factors for cervicothoracic junction Pseudarthrosis in the multivariate analysis. CONCLUSION: Overall Pseudarthrosis rates were similar between small rods and transitional constructs. There was higher complications rate, blood loss, and operating time associated with transitional constructs. Pseudarthrosis risk factors at the cervicothoracic junction include tobacco use, corpectomy, lack of an anterior construct, and longer constructs. LEVEL OF EVIDENCE: 3.
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Pseudarthrosis in multilevel anterior cervical fusion with rhbmp 2 and allograft analysis of one hundred twenty seven cases with minimum two year follow up
Spine, 2010Co-Authors: Hong Xing Shen, Jacob M Buchowski, Jin Sup Yeom, Daniel K RiewAbstract:STUDY DESIGN: Consecutive case series. OBJECTIVE: The purpose of this study was to analyze the Pseudarthrosis rate in a large series of recombinant human bone morphogenetic protein-2 (rhBMP-2) augmented multilevel (> or =3 levels) anterior cervical fusions. SUMMARY OF BACKGROUND DATA: The reported Pseudarthrosis rate following anterior cervical fusion varies from 0% to 20% for single-level and up to 50% for multilevel fusions. It has been postulated that the use of rhBMP-2 may decrease the Pseudarthrosis rate. METHODS: A consecutive series of patients with cervical spondylosis and/or disc herniation who underwent anterior cervical fusion with rhBMP-2, structural allograft, and plate fixation with a minimum 2-year follow-up were analyzed by experienced, independent spine surgeons. RESULTS: A total of 127 patients (54 men and 73 women with mean age of 54 +/- 10 years [range, 32-79]) were examined. Seventy-five (59.1%) patients underwent a 3-level fusion, 34 (26.7%) underwent a 4-level fusion, and 18 (14.2%) underwent a 5-level fusion. Of the 451 fusion segments, 14 segments (3.1%) in 13 of 127 patients (10.2%) had evidence of Pseudarthrosis at 6 months following surgery. Of the 13 patients with a Pseudarthrosis, 3 had a 3-level fusion (3/75 patients [4.0%]), 6 had a 4-level fusion (6/34 patients [17.4%]), and 4 had a 5-level fusion (4/18 patients [22.2%]). Five patients were asymptomatic and were not revised, but the remaining 8 patients required additional surgery. In 12 of 13 patients with a Pseudarthrosis, the nonunion occurred at the lowest fusion level and at the cervicothoracic junction. The only statistically significant risk factor for developing a Pseudarthrosis was the number of fusion levels. CONCLUSION: In a large series of rhBMP-2 augmented multilevel fusions, the Pseudarthrosis rate was 10.2% at 6 months following surgery. Since the risk of Pseudarthrosis increases with the number of fusion levels, a long fusion lever arm may biomechanically overwhelm the biologic advantage of rhBMP-2. While rhBMP-2 is known to enhance fusion rates, it does not guarantee fusion in all situations.
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spinal fusion after revision surgery for Pseudarthrosis in adult scoliosis
Spine, 2006Co-Authors: Dhruv B Pateder, Ye Soo Park, Khaled M Kebaish, Brett M Cascio, Jacob M Buchowski, Edward W Song, Michael B Shapiro, John P KostuikAbstract:STUDY DESIGN: A retrospective study. OBJECTIVE.: To decipher the incidence, characteristics, functional outcomes, and complications of spinal fusion after revision surgery for recurrent Pseudarthrosis in adult patients with scoliosis. SUMMARY OF BACKGROUND DATA: While the rate of spinal fusion has been examined in the past, there have been no studies that have examined the incidence, characteristics, functional outcomes, and complications of spinal fusion after Pseudarthrosis repair in adult patients with scoliosis. MATERIALS AND METHODS: A total of 132 patients with failed spinal fusion surgery for adult scoliosis and painful pseudarthroses were studied. Each patient had an average of 3.7 spinal surgeries before undergoing revision at our institution. In addition to clinical assessment and imaging studies, Pseudarthrosis was confirmed intraoperatively in all patients. All patients underwent reinstrumentation and fusion along with adjunctive procedures as needed. Spinal fusion was assessed clinically and radiographically after surgery for a minimum of 40 months. Subjective functional outcomes and complications associated with the procedures were also studied. RESULTS: The overall incidence of spinal fusion after revision surgery for Pseudarthrosis in adult scoliosis was 90%. There was a propensity for Pseudarthrosis to recur at the thoracolumbar and lumbosacral junctions. Increasing thoracolumbar kyphosis and loss of sagittal balance were significant risk factors for recurrent Pseudarthrosis after revision surgery (mean thoracolumbar kyphosis of 23 degrees and mean sagittal balance of 7.9 cm anteriorly associated with persistent Pseudarthrosis). Additionally, patients with multiple preoperative sites of pseudarthroses were at a higher risk for continued Pseudarthrosis after surgery. Cigarette smoking, age, and surgical approach did not have any significant correlation with Pseudarthrosis. Seventy-two percent of patients were satisfied with the outcome and 80% would have chosen to undergo surgery again if necessary. Thirty-three percent of patients who underwent surgery had some complication related to the surgery. CONCLUSION: Revision surgery for Pseudarthrosis repair in adult scoliosis is most successful at attaining fusion when thoracolumbar and overall sagittal alignment are restored as much as possible.
Vedat Deviren - One of the best experts on this subject based on the ideXlab platform.
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revision surgery for lumbar Pseudarthrosis
The Spine Journal, 2015Co-Authors: Ozgur Dede, Sigurd Berven, Serena S. Hu, Daniel U Thuillier, Murat Pekmezci, Christopher P Ames, Vedat DevirenAbstract:Abstract Background context Revision surgery for Pseudarthrosis after a lumbar spinal fusion has unpredictable functional results. Purpose The aim of this study was to determine the clinical outcomes of revision surgery to fuse the Pseudarthrosis site based on the two most common diagnoses (degenerative disc disease [DDD] vs. spondylolisthesis). Study design Patients who had a revision surgery between 1995 and 2004 for lumbar Pseudarthrosis after short segment lumbar spinal fusion were identified through the institution's Spine Center surgery database. A retrospective chart review of clinical, hospital, and anesthesia records was then performed. Patient sample Sixty-six patients were included in the study (28 patients with DDD and 38 patients with spondylolisthesis). Inclusion criteria were a surgical diagnosis of Pseudarthrosis with a prior fusion of one or two motion segments, minimum 24 months of follow-up, and a diagnosis of either symptomatic DDD or spondylolisthesis as the primary indication for the index fusion surgery. Outcome measures The Oswestry disability index (ODI) and a self-assessment questionnaire were used to evaluate clinical outcomes. Methods A retrospective chart and radiographic review was performed. Statistical analysis was done using Student t test for ODI scores and chi-square test for discrete variables from the outcome questionnaires. Results Follow-up radiographs were available for 64 patients (97%), and a fusion rate of 100% was found in both groups for the radiographs examined. The mean postoperative ODI score was 53.3 (30–84.4) for DDD patients and 37.2 (2.5–76) for the spondylolisthesis group (p Conclusions The clinical outcomes after revision surgery for Pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of Pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
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Treatment of thoracic Pseudarthrosis in the adult: is combined surgery necessary?
Clinical Orthopaedics and Related Research, 2003Co-Authors: Sigurd Berven, Vedat Deviren, Serena S. Hu, David S. BradfordAbstract:: In deformity surgery in adults, Pseudarthrosis remains an important cause of progressive deformity and postoperative pain. Revision surgery for Pseudarthrosis in the lumbar spine is a difficult challenge with failure rates of as much as 50% using posterior surgery alone. Treatment of Pseudarthrosis of the thoracic spine has not been well-described. The purpose of the current study was to review the long-term clinical and radiographic results of posterior-only surgery for the treatment of Pseudarthrosis in the thoracic spine. Using a posterior extension osteotomy through the identified Pseudarthrosis with reinstrumentation and autogenous bone grafting, an improvement of regional sagittal balance was shown and reliable clinical outcomes were obtained. A single-stage posterior revision surgery with extension osteotomies through the regions of Pseudarthrosis coupled with rigid internal fixation and autogenous bone grafting is an effective technique for treatment of Pseudarthrosis of the thoracic spine. This technique improves regional sagittal deformity and leads to reliable arthrodesis. Combined anterior and posterior surgery was not necessary for effective treatment of thoracic Pseudarthrosis in this series.
