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Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors.

Publication ,  Journal Article
How, NE; Street, JT; Dvorak, MF; Fisher, CG; Kwon, BK; Paquette, S; Smith, JS; Shaffrey, CI; Ailon, T
Published in: Neurosurg Rev
June 2019

We conducted a systematic review with meta-analysis and qualitative synthesis. This study aims to characterize pseudarthrosis after long-segment fusion in spinal deformity by identifying incidence rates by etiology, risk factors for its development, and common features. Pseudarthrosis can be a painful and debilitating complication of spinal fusion that may require reoperation. It is poorly characterized in the setting of spinal deformity. The MEDLINE, EMBASE, and Cochrane databases were searched for clinical research including spinal deformity patients treated with long-segment fusions reporting pseudarthrosis as a complication. Meta-analysis was performed on etiologic subsets of the studies to calculate incidence rates for pseudarthrosis. Qualitative synthesis was performed to identify characteristics of and risk factors for pseudarthrosis. The review found 162 articles reporting outcomes for 16,938 patients which met inclusion criteria. In general, the included studies were of medium to low quality according to recommended reporting standards and study design. Meta-analysis calculated an incidence of 1.4% (95% CI 0.9-1.8%) for pseudarthrosis in adolescent idiopathic scoliosis, 2.2% (95% CI 1.3-3.2%) in neuromuscular scoliosis, and 6.3% (95% CI 4.3-8.2%) in adult spinal deformity. Risk factors for pseudarthrosis include age over 55, construct length greater than 12 segments, smoking, thoracolumbar kyphosis greater than 20°, and fusion to the sacrum. Choice of graft material, pre-operative coronal alignment, post-operative analgesics, and sex have no significant impact on fusion rates. Older patients with greater deformity requiring more extensive instrumentation are at higher risk for pseudarthrosis. Overall incidence of pseudarthrosis requiring reoperation is low in adult populations and very low in adolescent populations.

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Published In

Neurosurg Rev

DOI

EISSN

1437-2320

Publication Date

June 2019

Volume

42

Issue

2

Start / End Page

319 / 336

Location

Germany

Related Subject Headings

  • Spinal Fusion
  • Spinal Curvatures
  • Risk Factors
  • Reoperation
  • Pseudarthrosis
  • Neurology & Neurosurgery
  • Incidence
  • Humans
  • 3209 Neurosciences
  • 3203 Dentistry
 

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Chicago
ICMJE
MLA
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How, N. E., Street, J. T., Dvorak, M. F., Fisher, C. G., Kwon, B. K., Paquette, S., … Ailon, T. (2019). Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev, 42(2), 319–336. https://doi.org/10.1007/s10143-018-0951-3
How, Nathan E., John T. Street, Marcel F. Dvorak, Charles G. Fisher, Brian K. Kwon, Scott Paquette, Justin S. Smith, Christopher I. Shaffrey, and Tamir Ailon. “Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors.Neurosurg Rev 42, no. 2 (June 2019): 319–36. https://doi.org/10.1007/s10143-018-0951-3.
How, Nathan E., et al. “Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors.Neurosurg Rev, vol. 42, no. 2, June 2019, pp. 319–36. Pubmed, doi:10.1007/s10143-018-0951-3.
How NE, Street JT, Dvorak MF, Fisher CG, Kwon BK, Paquette S, Smith JS, Shaffrey CI, Ailon T. Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev. 2019 Jun;42(2):319–336.
Journal cover image

Published In

Neurosurg Rev

DOI

EISSN

1437-2320

Publication Date

June 2019

Volume

42

Issue

2

Start / End Page

319 / 336

Location

Germany

Related Subject Headings

  • Spinal Fusion
  • Spinal Curvatures
  • Risk Factors
  • Reoperation
  • Pseudarthrosis
  • Neurology & Neurosurgery
  • Incidence
  • Humans
  • 3209 Neurosciences
  • 3203 Dentistry