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KMID : 1001920190620050567
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Journal of Korean Neurosurgical Society
2019 Volume.62 No. 5 p.567 ~ p.576
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Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up
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Kim Yong-Chan
Kim Ki-Tack
Kim Cheung-Kue
Hwang Hyung-Seo
Jin Woo-Young
Lenke Lawrence G.
Cha Jae-Ryong
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Abstract
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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.
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KEYWORD
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Spine, Joint deformities, Acquired, Osteotomy, Pseudarthrosis, Conservative management
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