Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up
- Author:
Yong Chan KIM
1
;
Ki Tack KIM
;
Cheung Kue KIM
;
Il Yeong HWANG
;
Woo Young JIN
;
Lawrence G LENKE
;
Jae Ryong CHA
Author Information
- Publication Type:Original Article
- Keywords: Spine; Joint deformities, Acquired; Osteotomy; Pseudarthrosis; Conservative management
- MeSH: Animals; Braces; Follow-Up Studies; Humans; Joint Deformities, Acquired; Kyphosis; Lordosis; Male; Mental Health; Osteotomy; Pseudarthrosis; Scoliosis; Spine
- From:Journal of Korean Neurosurgical Society 2019;62(5):567-576
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection.METHODS: Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5–10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed.RESULTS: Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05).CONCLUSION: Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.
