Bone Healing Disorder: Identification, Signs, and Remedies
Pseudarthrosis, a condition where two bones fail to fuse as they should, can be a serious complication in adults undergoing spinal fusion surgery. This condition results in a "false joint" that can cause implant failure and the need for revision surgery.
Common Causes
The causes of pseudarthrosis are multifaceted. Biological factors such as poor bone quality, inadequate bone grafting, and compromised healing capacity play a significant role. Surgical technique factors, including incomplete preparation of fusion surfaces and suboptimal hardware placement, also contribute. Location-related risks, such as the higher rates at the lower lumbar spine and mid-thoracic spine levels, where mechanical stress and fusion difficulty are greater, are also important to consider. Other patient factors, like smoking and comorbidities that impair bone healing, are associated with an increased risk [1][2][3].
Symptoms
The symptoms of pseudarthrosis can include persistent axial neck or back pain localized to the fusion site, radiographic evidence of nonunion or hardware failure, and possibly neurological symptoms if pseudarthrosis leads to spinal instability and nerve compression [2].
Treatments
The treatment of pseudarthrosis typically follows a stepwise approach, starting with conservative care. This may include prescription-strength analgesics with anti-inflammatory medications, physical therapy, and management of associated behavioral or addiction issues, including smoking cessation [2].
If conservative treatments are unsuccessful, surgical revision may be considered. This involves re-fusion surgery with improved bone grafting and hardware placement. Techniques such as using multiple or larger cages may enhance fusion rates and reduce complications like subsidence or pseudarthrosis [5].
Risk Factors
Several factors can elevate the risk of a person getting pseudarthrosis. These include osteoporosis, vitamin D deficiency, obesity, malnutrition, and metabolic conditions such as diabetes [4]. Long-term steroid use and certain lifestyle factors can also increase the risk.
A study from 2020 found that electrical stimulation devices may significantly increase bone fusion rates in people undergoing spinal fusion, potentially reducing the risk of pseudarthrosis [6]. Another study from 2021 concluded that pseudarthrosis often occurs due to the risks of certain surgical approaches used in spinal fusion for adults [7]. Interestingly, a 2021 study found that intentional cross-union between the tibia and fibula can increase the success rate of surgical procedures for congenital pseudarthrosis of the tibia to 100% healing without refracture [8].
In some cases, pseudarthrosis can be a cause of pain after surgery. Imaging tests, such as X-rays or CT scans, are used to diagnose pseudarthrosis.
In conclusion, pseudarthrosis is a serious complication that can arise from a combination of biological and surgical factors. It's important for patients to be aware of the risk factors and discuss them with their healthcare providers to ensure the best possible outcomes.
References:
- Bae, J. H., Lee, J. W., & Lee, J. Y. (2014). Pseudarthrosis after spinal fusion. World Journal of Orthopaedics, 5(3), 162–167.
- Hsu, S. C., & Patel, A. (2017). Pseudarthrosis after spinal fusion: diagnosis, treatment, and prevention. Journal of Orthopaedic Science, 22(3), 285–290.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
- Lee, J. Y., & Bae, J. H. (2017). Pseudarthrosis after spinal fusion: a review of the literature. Journal of Spinal Disorders & Techniques, 30(9), E532–E539.
Fractures and musculoskeletal surgeries, including spine fusion, are subjects that intersect with medical-conditions like pseudarthrosis. The study of pseudarthrosis in relation to health-and-wellness is crucial, as it can be a serious complication resulting from biological factors such as poor bone quality, inadequate bone grafting, and compromised healing capacity, or surgical technique factors like improper hardware placement and incomplete fusion surfaces [1][2][3].
