TY - JOUR
T1 - Pseudarthrosis in primary fusions for adult idiopathic scoliosis
T2 - Incidence, risk factors, and outcome analysis
AU - Kim, Yongjung J.
AU - Bridwell, Keith H.
AU - Lenke, Lawrence G.
AU - Rinella, Anthony S.
AU - Edward, Charles
PY - 2005/2/15
Y1 - 2005/2/15
N2 - Study Design. A retrospective study. Objective. To analyze the incidence, characteristics, risk factors, and Scoliosis Research Society Instrument-24 (SRS-24) outcome scores of pseudarthrosis in adult idiopathic scoliosis primary fusions. Summary of Background Data. The healing of spinal fusion is complex and difficult to study in a clinical setting, there are no detailed reports on pseudarthrosis in primary fusion for adult idiopathic scoliosis since the introduction of "modern" segmental fixation techniques. Methods. A retrospective chart and radiographic review of 96 patients (average age 42:2 years; range 18.2-62.9 years) with adult idiopathic scoliosis undergoing first time (primary) spinal instrumentation and fusion with a minimum 2-year follow-up (average 5.9 years; range 2-16.8 years) treated at a single institution between 1985 and 2001 were analyzed. Results. Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with pseudarthrosis (P = 0:03). Smoking history and comorbidity did not increase the pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (≥70°) and a greater thoracic kyphosis (T5-T12 >40°) did not correlate with a higher pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 ≥20°) correlated with a significantly higher pseudarthrosis rate (P < 0.0001 ). Preoperative global sagittal and coronal imbalance did not increase the pseudarthrosis rate (P = 0.45 and 0.62, respectively). Patients with pseudarthrosis had lower SRS-24 scores than those without (P = 0.01). Conclusion. The incidence of pseudarthrosis following adult idiopathic scoliosis primary fusion was 17%. The pseudarthrosis was most likely to occur at the thoraco-lumbar junction. Older patients (>55 years), longer fusion (> 12 vertebrae) and those with thoracolumbar kyphosis (≥20°); demonstrated: increased risk for pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the pseudarthrosis.
AB - Study Design. A retrospective study. Objective. To analyze the incidence, characteristics, risk factors, and Scoliosis Research Society Instrument-24 (SRS-24) outcome scores of pseudarthrosis in adult idiopathic scoliosis primary fusions. Summary of Background Data. The healing of spinal fusion is complex and difficult to study in a clinical setting, there are no detailed reports on pseudarthrosis in primary fusion for adult idiopathic scoliosis since the introduction of "modern" segmental fixation techniques. Methods. A retrospective chart and radiographic review of 96 patients (average age 42:2 years; range 18.2-62.9 years) with adult idiopathic scoliosis undergoing first time (primary) spinal instrumentation and fusion with a minimum 2-year follow-up (average 5.9 years; range 2-16.8 years) treated at a single institution between 1985 and 2001 were analyzed. Results. Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with pseudarthrosis (P = 0:03). Smoking history and comorbidity did not increase the pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (≥70°) and a greater thoracic kyphosis (T5-T12 >40°) did not correlate with a higher pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 ≥20°) correlated with a significantly higher pseudarthrosis rate (P < 0.0001 ). Preoperative global sagittal and coronal imbalance did not increase the pseudarthrosis rate (P = 0.45 and 0.62, respectively). Patients with pseudarthrosis had lower SRS-24 scores than those without (P = 0.01). Conclusion. The incidence of pseudarthrosis following adult idiopathic scoliosis primary fusion was 17%. The pseudarthrosis was most likely to occur at the thoraco-lumbar junction. Older patients (>55 years), longer fusion (> 12 vertebrae) and those with thoracolumbar kyphosis (≥20°); demonstrated: increased risk for pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the pseudarthrosis.
KW - Adult idiopathic scoliosis
KW - Primary fusion
KW - Pseudarthrosis
UR - http://www.scopus.com/inward/record.url?scp=13844312354&partnerID=8YFLogxK
U2 - 10.1097/01.brs.0000153392.74639.ea
DO - 10.1097/01.brs.0000153392.74639.ea
M3 - Review article
C2 - 15706346
AN - SCOPUS:13844312354
SN - 0362-2436
VL - 30
SP - 468
EP - 474
JO - Spine
JF - Spine
IS - 4
ER -