J Korean Neurosurg Soc.  2019 Sep;62(5):567-576. 10.3340/jkns.2018.0191.

Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up

• Kim YC
• Kim KT
• Kim CK
• Hwang IY
• Jin WY
• Lenke LG
• Cha JR

• KMID: 2457947
• DOI: http://doi.org/10.3340/jkns.2018.0191

Abstract

OBJECTIVE
Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection.
METHODS
Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5-10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed.
RESULTS
Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05).
CONCLUSION
Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.

Keyword

Spine; Joint deformities, Acquired; Osteotomy; Pseudarthrosis; Conservative management

MeSH Terms

Animals
Braces
Follow-Up Studies*
Humans
Joint Deformities, Acquired
Kyphosis
Lordosis
Male
Mental Health
Osteotomy*
Pseudarthrosis*
Scoliosis
Spine

Figure

• 

  Fig. 1. A 70-year-old female had sagittal imbalance due to proximal junctional kyphosis occurring after pedicle subtraction osteotomy. A : Standing AP and lateral radiographs at 1 year after pedicle subtraction osteotomy. B : Standing AP and lateral radiographs at 2 months after three column osteotomy. C : Standing AP and lateral radiographs at 4 years after three column osteotomy presents bilateral rod breakage at lumbosacral junction in which anterior spinal fusion in L5–S1 was performed. D : Standing AP and lateral radiographs at 6 years after detection of pseudarthrosis. AP : anteroposterior.

• 

  Fig. 2. A 72-year-old female had sagittal imbalance due to degenerative lumbar kyphoscoliosis. A : Standing AP and lateral radiograph before pedicle subtraction osteotomy. B : Standing AP and lateral radiographs at 2 months after pedicle subtraction osteotomy on L3. C : Standing AP and lateral radiographs at 2 years after pedicle subtraction osteotomy presents right rod breakage at pedicle subtraction osteotomy site. The arrow indicating the broken portion of the rod. D : Standing AP and lateral radiographs at 5 years after detection of pseudarthrosis. The arrow indicating the broken portion of the rod. AP : anteroposterior.

Reference

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