A fusion surgery typically works to limit movement in the impacted area of your neck or back with the end goal of minimizing or eliminating pain. It also works to restore stability to your spine after the surgeon removes a damaged disc. However, a fusion may fail to form as the surgeon predicts. When this happens, it’s called pseudarthrosis or a non-union. This term describes a spinal fusion that wasn’t successful. Here’s a quick overview of pseudarthrosis causes, symptoms, and treatment options available.
This condition can happen in any part of the spine that your surgeon attempts a spinal fusion. Fusion surgery’s ultimate goal is to join two vertebrae together to make one solid piece, and the surgeon does this using either an anterior cervical discectomy and fusion or an anterior lumbar interbody fusion. The graft material may fail to allow your spinal fusion to form completely to make a solid piece of bone tissue, and this allows the area to continue to move.
This condition usually comes from poor bone healing after your surgeon performs your spinal fusion. Sometimes, a surgical oversight can cause it to fail, but so can long-term patient habits. For example, smoking can lower your chances of having a successful spinal fusion by a significant amount. If you take some medications like steroids, this can block the body’s natural healing processes enough that your surgery fails. A few additional risk factors include:
- Hunter syndrome or metabolic disorders
- Osteoporosis or chronic illnesses
- Uncontrolled diabetes
Risk Factors for Pseudarthrosis
If you’ve chosen to have a spinal fusion while having one of the following risk factors, your chances of developing this condition are higher:
- Being a smoker or regularly using tobacco products
- Being malnourished
- Being overweight or obese
- Having diabetes
- Having osteoporosis
- Having a metabolic disorder
- Using steroids for an extended time
After you have your fusion surgery, you typically have to follow restrictions for three months. Right after the surgical procedure, most patients feel a good amount of relief from any pain they had before surgery. However, there is some discomfort around the incision site. Once you pass the three-month restriction period and you go back to your normal activities, it’s normal to feel some pain.
However, if you have a return of the pain levels you had prior to surgery, your pain gets worse, or you start experiencing neurological symptoms like tingling or numbness, you may have pseudarthrosis. The pain is usually neck or back pain, and it tends to radiate to your sides. If you have several levels treated during one procedure, you have an increased risk of a fusion failure.
If you have had spinal surgery and you’re still experiencing pain, your doctor will schedule a visit and go over your medical history thoroughly. They’ll also look at any previous x-rays you had, and they could schedule more. The main goal of any surgical procedure is to treat your symptoms and return you to a better quality of life. If you did well for a few months after your surgery but had your pain and symptoms come back, you could have had a spinal fusion failure. This is especially true if the pain mimics where it was and the severity level before you had surgery.
In order for your doctor to know for sure if you had a non-union, they’ll take more x-rays. This will help them evaluate your spine. The x-rays usually involve extension, flexion, lateral, and standing AP images. On an x-ray, bones can look dense, with the discs looking black. A spinal fusion surgery works to remove the disc so bone forms between two vertebral bodies. In turn, this makes it look like one solid unit. If a non-union happened, you’ll see darkness on the x-ray where you should see solid bone. The doctor may also see motion on your extension and standing flexion x-rays that isn’t normal in a correctly healed spinal fusion. They may require you to get a CT scan to help get a closer look at the area, and it’s a common way to confirm that you have a non-union.
Pseudarthrosis Treatment Options
If your symptoms are mild or nonexistent, you may not need any further treatment. Some patients who have a failed spinal fusion surgery can respond very well to physical therapy, medications, and non-surgical attempts to manage their pain levels. However, this isn’t usually the case.
Revision surgery is a very popular treatment option. Before a revision surgery, x-rays could be taken to make sure there are no other causes of your pain. For example, some patients don’t notice any symptoms until several months after surgery, and this can make diagnosing a failed spinal fusion surgery challenging. If you do undergo a second spinal fusion, the surgical team might:
- Correct any existing hardware from your first surgery
- Utilize another approach to your second fusion surgery than you had in the first
- Utilize another type of bone graft material
Your surgeon’s ability doesn’t always dictate the results of your spinal fusion. Your risk for developing pseudarthrosis is typically under 20%, but the chance is still there. There’s no concrete guarantee with any type of spinal surgery, but you can do a few things to increase your chances of success. You should stick to healthy exercise habits, watch your diet, and follow your surgeon’s instructions as you recover. The advancements in medical technology have reduced the risk of a non-union after spinal surgery, and this is great news.
Contact Florida Spine Associates
If you have more questions about spinal fusion or you think you have a non-union, contact us at Florida Spine Associates. We're willing to sit down with you, schedule consultations, and go over your symptoms and treatment options to help improve your quality of life.