Pseudarthrosis Following Lumbar and Lumbosacral Fusion Using the Antepsoas Technique. Issue 24 (15th December 2021)

• Record Type: Journal Article
• Authors: Tannoury, Chadi; Bhale, Rahul; Vora, Molly; Saade, Aziz; Kortbawi, Rabih; Orlando, Giuseppe; Das, Avilash; Tannoury, Tony
• Is Part Of: Spine. Volume 46:Issue 24(2021)
• Page Start: 1690
• Page End: 1695
• Publication Date: 2021-12-15
• Subjects: ALIF -- antepsoas -- fusion rate -- iliopsoas -- interbody fusion -- lumbar fusion -- minimally invasive -- MIS-ATP -- OLIF -- prepsoas -- pseudarthrosis -- transpsoas -- XLIF; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000004115
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Pseudarthrosis is a feared complication following spinal fusions. In 220 patients treated with minimally invasive antepsoas-lumbar fusions, arthrodesis was evaluated using follow-up computed tomography scans. Successful fusion was noted in 96.4% of operated patients and 98.3% of the fused levels. Nonetheless, smoking history, multilevel fusions, and surgery at L5-S1 remain considerable risk factors. Abstract : Study Design: Retrospective case–control study. Objective: The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions. Summary of Background Data: Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis. Methods: This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1–4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis. Results: A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were "definitely fused" and 40 levels [5.8%] were "Likely fused") and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were "likely not fused" and five levels (0.7%) were "definitely not fused"). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0–2%). Of 127 smokers, six developed pseudarthrosis (odds ratio = 2.3, P = 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients). Conclusion: The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers. Level of Evidence: 4