Pseudarthrosis of the lumbar spine is the result of a failed attempt at spinal fusion. Pseudarthrosis typically presents as either low back pain or leg pain that occurs months to years after a previous lumbar fusion.
One of the goals of lumbar fusion surgery is for the bones to heal together or "weld" into one solid piece of bone. For lumbar fusion, bone graft is used to achieve this goal and the fusion heals much in the same way a broken bone heals in a cast. If the bones do not "weld together" properly, then motion may continue across the area. For some patients, motion in the area of previous fusion can cause pain similar to that of a broken bone that never heals. Many patients with pseudarthrosis do not have any particular symptoms, and for these patients further treatment and evaluation is not always needed. When needed, x-rays and CT scans of the spine may be used to determine if a spinal fusion has occurred.
There are a number of different risk factors for development of pseudarthrosis. Many of these are related to other medical conditions a patient may have. Patients who smoke, use other tobacco products, or have diabetes mellitus are at increased risk for the development of Pseudarthrosis.
Recent surgical advances including the use of spinal instrumentation, bone graft substitutes, and genetic engineering (bone morphogenetic protein) have helped surgeons to decrease the risk of pseudarthrosis after spine fusion surgery. For patients who have a pseudoarthrosis that is causing symptoms, treatment typically involves a second surgery to obtain a solid fusion.
This patient is a healthy 35-year old gentleman who had lumbar fusion surgery to treat degeneration of the lowest disc in his back. After the surgery he noticed increasing pain in his back with radiating pain into the leg. His symptoms eventually got the point where he was unable to work or even take care of his children and he decided to get a second opinion at the Virginia Spine Institute.
Figure 1: His x-rays on his first visit to Virginia Spine Institute show previous lumbar surgery with screws and rods; however the bone has failed to heal into a solid fusion and pseudarthrosis has developed (red arrows).
Figure 2: CT scan of the lumbar spine demonstrating pseudarthrosis (red arrows). The line seen between the bones indicates an area where the bones did not heal together after surgery.
Figure 3: The patient underwent a second surgery with the surgeons at the Virginia Spine Institute and a new fusion surgery was performed on both the front and back of the lumbar spine. His x-rays after surgery show solid fusion and he has returned back to work and his normal activities including exercise and weight lifting without any further pain at this time.