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Neurosurgical Review
Published in: Neurosurgical Review 2/2019

01-06-2019 | Review

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

Authors: Nathan E. How, John T. Street, Marcel F. Dvorak, Charles G. Fisher, Brian K. Kwon, Scott Paquette, Justin S. Smith, Christopher I. Shaffrey, Tamir Ailon

Published in: Neurosurgical Review | Issue 2/2019

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Abstract

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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Metadata
Title
Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors
Authors
Nathan E. How
John T. Street
Marcel F. Dvorak
Charles G. Fisher
Brian K. Kwon
Scott Paquette
Justin S. Smith
Christopher I. Shaffrey
Tamir Ailon
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 2/2019
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-018-0951-3

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