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Semin Plast Surg 2021; 35(01): 054-062
DOI: 10.1055/s-0041-1726102
Review Article

Failure in Lumbar Spinal Fusion and Current Management Modalities

Alex Cruz
1   Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
,
Alexander E. Ropper
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
,
David S. Xu
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
,
Michael Bohl
3   Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
,
Edward M. Reece
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
4   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Sebastian J. Winocour
4   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Edward Buchanan
4   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
5   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Geoffrey Kaung
1   Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding Dr. Ropper receives consulting fees from Globus Medical and Stryker, but these fees have no conflict with this report.
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Abstract

Lumbar spinal fusion is a commonly performed procedure to stabilize the spine, and the frequency with which this operation is performed is increasing. Multiple factors are involved in achieving successful arthrodesis. Systemic factors include patient medical comorbidities—such as rheumatoid arthritis and osteoporosis—and smoking status. Surgical site factors include choice of bone graft material, number of fusion levels, location of fusion bed, adequate preparation of fusion site, and biomechanical properties of the fusion construct. Rates of successful fusion can vary from 65 to 100%, depending on the aforementioned factors. Diagnosis of pseudoarthrosis is confirmed by imaging studies, often a combination of static and dynamic radiographs and computed tomography. Once pseudoarthrosis is identified, patient factors should be optimized whenever possible and a surgical plan implemented to provide the best chance of successful revision arthrodesis with the least amount of surgical risk.

Keywords

lumbar spinal fusion - neurosurgery - spine surgery - pseudoarthrosis


Publication History

Article published online:
10 May 2021

© 2021. Thieme. All rights reserved.

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