Pseudoarthrosis

The spine is made up of individual vertebra linked together by a disc in the front and 2 small joints in the back of the spine—similar to the links in a watchband. The "links" or joints allow bending and twisting of the spine. These joints frequently become worn out, or arthritic, with aging or following injury, and eventually become painful. If pain is not controlled with physical therapy, exercise, and medication, a fusion may be suggested by your physician to stabilize the arthritic part(s) of the spine. Better methods of selecting patients for surgery, as well as better surgical techniques have made pseudoarthrosis a less common outcome of spinal fusion surgery.

Pseudoarthrosis is derived from a Greek term meaning "false joint". The term is used to describe the outcome of surgery that does not result in a solid fusion, which occurs more commonly in elderly patients, smokers, patients with medical problems, and patients on certain medications. Other conditions with an increased risk of pseudoarthrosis are:

• Obesity
• Osteoporosis
• Chronic steroid use
• Diabetes mellitus
• Other chronic illnesses
• A previous pseudoarthrosis
• Malnutrition

Symptoms

A surgeon may have difficulty determining if pseudoarthrosis is present. If pseudoarthrosis has occurred, a recurrence of pain very similar in location to that before surgery will often be noted over a period of months, or the pain may gradually increase shortly after surgery.

Imaging Evaluation

• Computerized tomography (CT) scan is the best study to identify pseudoarthrosis
• X-rays may demonstrate loosening or breakage if instrumentation was used in surgery

Treatment

If a painful pseudoarthrosis is identified, your spinal surgeon will make further recommendations for additional treatment, which may include additional surgery.