Seminars in Spine Surgery
Volume 20, Issue 1 , Pages 20-26 , March 2008

Update on the Diagnosis and Treatment of Lumbar Nonunions

  • Alpesh A. Patel, MD

      Affiliations

    • Department of Orthopaedic Surgery, Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT.
    • Corresponding Author InformationAddress reprint requests to Alpesh A. Patel, MD, 590 Wakara Way, University of Utah Orthopaedic Center, Salt Lake City, UT 84108.
  • ,
  • William R. Spiker, MD

      Affiliations

    • Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.

References 

  1. Albee FH. Transplantation of a portion of the tibia into the spine for Pott’s disease. J Bone Joint Surg. 1911;57:885–886
  2. Becker C. Spine-tingling prospects: artificial disk implants are among the new technologies expected to revolutionize the outcomes of back surgery. Mod Healthcare. 2003;33:30–32
  3. In:  Crenshaw AH editors. Campbell’s Operative Orthopaedics: Nonunion and Malunion. St. Louis, MO: Mosby Year Book; 1992;
  4. Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res. 2004;419:71–75
  5. Swank S, Lonstein JE, Moe JH, et al. Surgical treatment of adult scoliosis (A review of two hundred and twenty-two cases). J Bone Joint Surg Am. 1981;63:268–287
  6. Stauffer RN, Coventry MB. Anterior interbody lumbar spine fusion (Analysis of Mayo Clinic series). J Bone Joint Surg Am. 1972;54:756–768
  7. Stauffer RN, Coventry MB. Posterolateral lumbar spine fusion (Analysis of Mayo Clinic series). J Bone Joint Surg Am. 1972;54:1195–1204
  8. Bridwell KH, Sedgewick TA, O’Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord Tech. 1993;6:461–472
  9. Fischgrund JS, Mackay M, Herkowitz HN, et al. 1997 Volvo Award winner in clinical studies (Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal fusion). Spine. 1997;22:2807–2812
  10. Brantigan JW, Neidro A, Toohey JS. The lumbar I/F cage for posterior lumbar interbody fusion with the variable screw placement system: 10 year results of a Food and Drug Administration clinical trial. Spine J. 2004;4:681–688
  11. Fritzell P, Hagg O, Wessberg P, et al. Chronic low back pain and fusion: a comparison of three surgical techniques: A prospective multicenter randomized study from the Swedish Lumbar Spine Study Group. Spine. 2002;27:1131–1141
  12. Boden SD, Schimandle JH, Hutton WC, et al. 1995 Volvo Award in basic sciences (The use of an osteoinductive growth factor for lumbar spinal fusion. Part I: biology of spinal fusion). Spine. 1995;20:2626–2632
  13. Toribatake Y, Hutton WC, Tomita K, et al. Vascularization of the fusion mass in a posterolateral intertransverse process fusion. Spine. 1998;23:1149–1154
  14. Rothman RH, Booth R. Failures of spinal fusion. Orthop Clin North Am. 1975;6:299–304
  15. Brown CW, Orme TJ, Richardson HD. The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine. 1986;11:942–943
  16. Daftari TK, Whitesides TE, Heller JG, et al. Nicotine on the revascularization of bone graft (An experimental study in rabbits). Spine. 1994;19:904–911
  17. Silcox DH, Daftari T, Boden SD, et al. The effect of nicotine on spinal fusion. Spine. 1995;20:1549–1553
  18. Mundoz M, Garcia-Vallejo JJ, Sempere JM, et al. Acute phase response in patients undergoing lumbar spinal surgery: modulation by perioperative treatment with naproxen and famotidine. Eur Spine J. 2004;13:367–373
  19. Riew KD, Long J, Rhee J, et al. Time-dependent inhibitory effects of indomethicin on spinal fusion. J Bone Joint Surg Am. 2003;85:632–634
  20. Martin GJ, Boden SD, Titus L. Recombinant human bone morphogenetic protein-2 overcomes the inhibitory effect of ketolorac, a nonsteriodal antiinflammatory drug (NSAID), on posterolateral lumbar intertransverse process spinal fusion. Spine. 1999;24:2188–2193
  21. Dimar JR, Ante WA, Zhang YP, et al. The effects of nonsteriodal anti-inflammatory drugs on posterior spinal fusion in the rat. Spine. 1996;21:1870–1876
  22. Sawin PD, Dickman CA, Crawford NR, et al. The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis. J Neurosurg. 2001;94(suppl):76–81
  23. Bouchard JA, Koka A, Bensusan JS, et al. Effects of irradiation on posterior spinal fusions: a rabbit model. Spine. 1994;19:1836–1841
  24. Ames CP, Smith JS, Preul MC, et al. Effect of recombinant human bone morphogenetic protein-2 in an experimental model of spinal fusion in a radiated area. Spine. 2005;30:2585–2592
  25. Sama AA, Khan SN, Myers ER, et al. High dose alendronate uncouples osteoclast and osteoblast function: a study in a rat spine pseudarthrosis model. Clin Orthop Relat Res. 2004;425:135–142
  26. Huang RC, Khan SN, Sandhu HS, et al. Alendronate inhibits spine fusion in a rat model. Spine. 2005;30:2516–2522
  27. Xue Q, Li H, Zou X, et al. The influence of alendronate treatment and bone graft volume on posterior lateral spine fusion in a porcine model. Spine J. 2005;30:1116–1121
  28. Lehman RA, Kuklo TR, Freedman BA, et al. The effect of alendronate sodium on spinal fusion: a rat model. Spine J. 2004;4:36–43
  29. Pateder DB, Park YS, Kebaish KM, et al. Spinal fusion after revision surgery for pseudarthrosis in adult scoliosis. Spine. 2006;31:E314–E319
  30. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalance and risk factor analysis in 144 cases. Spine. 2006;31:2329–2336
  31. Suda K, Ito M, Abumi K, et al. Radiological risk factors of pseudarthrosis and/or instrument breakage after PLF with pedicle screw system in isthmic spondylolisthesis. J Spinal Disord Tech. 2006;18:541–546
  32. Cotler JM, Star AM. Complications of spinal fusion. In:  Cotler JM,  Cotler HB editor. Spinal Fusion: Science and Technique. New York, NY: Springer-Verlag; 1990;p. 361–387
  33. Mermer MJ, Gupta MC, Wheeler DL, et al. Efficacy of osteogenic protein-1 in a challenging multilevel fusion model. Spine. 2004;29:249–256
  34. Watkins MB, Bragg C. Lumbosacral fusion: results with early ambulation. Surg Gynecol Obstet. 1956;102:604–606
  35. Bosworth DM. Technique of spina fusion: Pseudarthrosis and method of repair. In:  Blount WP,  Banks SW editor. AAOS Instructional Course Lectures. St. Louis, MO: Mosby; 1948;
  36. Hannon KM, Wetta WJ. Failure of technetium bone scanning to detect pseudarthroses in spinal fusion for scoliosis. Clin Orthop Relat Res. 1977;123:42–44
  37. Heggeness MH, Esses SI, Mody DR. A histological study of lumbar pseudarthrosis. Spine. 1993;18:1016–1020
  38. Sandhu HS, Toth JM, Diwan AD, et al. Histological evaluation of the efficacy of rhBMP-2 compared with autograft bone in sheep spinal anterior interbody fusion. Spine. 2002;27:567–565
  39. Benli IT, Ates B, Akalin S, et al. Miniumum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation. Eur Spine J. 2007;16:381–391
  40. Hayes MA, Howard TC, Gruel CR, et al. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 1989;14:327–331
  41. Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? (Correlation of routine radiographs with a second surgical look at lumbar fusions). Spine. 1993;18:1186–1189
  42. Brodsky AE, Kovalsky ES, Khalil MA. Correlation of radiologic assessment of lumbar spine fusions with surgical exploration. Spine. 1991;16(suppl):S261–S265
  43. Dawson EG, Clader TJ, Bassett LW. A comparison of different methods used to diagnose pseudarthrosis following posterior spinal fusion for scoliosis. J Bone Joint Surg Am. 1985;67:1153–1159
  44. Kant AP, Daum WJ, Dean SM, et al. Evaluation of lumbar spine fusion (Plain radiographs versus direct surgical exploration and observation). Spine. 1995;20:2313–2317
  45. Rothman RH, Glenn WV. CT evaluation of interbody fusion. Clin Orthop Relat Res. 1985;193:47–56
  46. Zinreich SJ, Ung DM, Davis R, et al. Three-dimensional CT imaging in postsurgical “failed back” syndrome. J Comp Assisted Tomogr. 1990;14:574
  47. McMaster MJ, Merrick MV. The scintigraphic assessment of the scoliotic spine after fusion. J Bone Joint Surg Br. 1980;62:65–72
  48. Hilibrand AS, Dina S. The use of diagnostic imaging to assess spinal arthrodesis. Orthop Clin North Am. 1998;29:591–601
  49. Jacobson JA, Starok M, Pathria MN, et al. Pseudarthrosis: US evaluation after posterolateral spinal fusion: work in progress. Radiology. 1997;204:853–858
  50. Djukic S, Lang P, Morris J, Hoaglund F, et al. The postoperative spine—magnetic resonance imaging. Orthop Clin North Am. 1990;21:603–624
  51. Lauerman WC, Bradford DS, Transfeldt EE, et al. Management of pseudarthrosis after arthrodesis of the spine for idiopathic scoliosis. J Bone Joint Surg Am. 1991;73:222–236
  52. Kim SS, Michelsen CB. Revision surgery for failed back syndrome. Spine. 1992;17:957–960
  53. Thalgott J, LaRocca H, Gardner V, et al. Reconstruction of failed lumbar surgery with narrow AO DCP plates for spinal arthrodesis. Spine. 1991;16(suppl):S170–S175
  54. Cassinelli EH, Wallach C, Hanscom B, et al. Prospective clinical outcomes of revision fusion surgery in patients with pseudarthrosis after posterior lumbar interbody fusions using stand-alone metallic cages. Spine J. 2006;6:428–434
  55. Freeman BJ, Licina P, Mehdian SH. Posterior lumbar interbody fusion combined with posterolateral fusion: 5 year results in 60 patients. Eur Spine J. 2000;9:42–46
  56. Cohen DB, Chotivichit A, Fujita T, et al. Pseudarthrosis repair: autogenous iliac crest versus femoral ring allograft. Clin Orthop Relat Res. 2000;371:46–55
  57. Buttermann GR, Glazer PA, Hu SS, et al. Revision of failed lumbar fusions (A comparison of anterior autograft and allograft). Spine. 1997;22:2748–2755
  58. Gertzbein SD, Hollopeter MR, Hall S. Pseudarthrosis of the lumbar spine (Outcome after circumferential fusion). Spine. 1998;23:2352–2356
  59. Albert TJ, Pinto M, Denis F. Management of symptomatic lumbar pseudarthrosis with anteroposterior fusion (A functional and radiographic outcome study). Spine. 2000;25:123–129
  60. Urist MR. Bone: formation by autoinduction. Science. 1965;150:893–899
  61. Burkus JK, Heim SE, Gormet MF, et al. Is Infuse bone graft superior to autograft bone? (An integrated analysis of clinical trials using the LT-Cage lumbar tapered fusion device). J Spinal Disord Tech. 2003;16:113–122
  62. Glassman SD, Carreon L, Djurasovic M, et al. Posterolateral lumbar spine fusion with infuse bone graft. Spine J. 2007;7:44–49
  63. Vaccaro AR, Anderson DG, Patel T, et al. Comparison of OP-1 Putty (rhBMP-7) to iliac crest autograft for posterolateral lumbar arthrodesis: a minimum 2-year follow-up pilot study. Spine. 2005;30:2709–2716

PII: S1040-7383(07)00128-1

doi: 10.1053/j.semss.2007.11.004

Seminars in Spine Surgery
Volume 20, Issue 1 , Pages 20-26 , March 2008