Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis 1).
Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques 2).
The management of lumbar pseudarthrosis requires careful planning, as well as intra-operative attention to detail, for revision surgery to be successful. Circumferential procedures have shown success in revision posterolateral and interbody fusion failures 3).
Diagnostic work-up of these cases include flexion and extension radiographs and CT scans. MRI can also be helpful to identify any residual or new areas of nerve compression. The most definitive test to identify a pseudoarthosis is an exploration of the fusion. This is performed when there is sufficient clinical and radiographic data to suggest the presence of a non-union. Given the associated morbidities and high financial expense, careful thought must be exercised by the responsible physician in the selection of the appropriate patient population for revision surgery. Prior to attempted salvage of arthrodesis, other causes of persistent low back pain should be ruled out and more conservative measures of treatment should be tried first 4).