Functional Outcomes After Revision Fusion After Pseudoarthrosis: A Systematic Review of Literature

Introduction: Pseudoarthrosis occurs in 10-30% of spinal fusions, with failure rates up to 40-70% even after revision. Following lumbar fusion, it often results in severe symptoms and poor postoperative outcomes, impacting quality of life, work absence, and stress levels. This systematic review aims to examine the functional outcomes of revision fusion after pseudoarthrosis.

Methods: The authors performed a PRISMA guidelines-based systematic review of the literature. Only articles detailing functional outcomes of patients who developed pseudarthrosis following revision and were treated with fusions were included. Information was extracted from each article in regards to type of revision procedure, and pre and postoperative Oswestry Disability Index (ODI), Back Pain, Neck Pain, complication rates, and postoperative pseudoarthrosis.

Results: The search resulted in 276 articles of which five articles were included in the study. Of the included studies there were 365 unique patients. Of these patients 48% were male and 52% were female. The average age of all patients was 53. The most common revision procedure was posterolateral interbody fusion with 279 patients. The average change in ODI was demonstrated to be 10.2 (18%). The average improvement in back and leg pain was 2.2 (31%) and 1.2 (17%) respectively. No included studies mentioned patient satisfaction postoperatively. Following the revision procedures, the rate of pseudoarthrosis was reported to be 6% to 28%. The reoperation rate of these procedures was demonstrated to be 29%.

Conclusion : Treatment post-fusion pseudarthrosis seems to reduce disability and pain. Yet, its effectiveness compared to conservative management and patient satisfaction is unclear. This review found a similar post-revision pseudarthrosis risk and a 29% reoperation rate. This data aids in discussing revision fusion choices for pseudoarthrosis. More research is required to pinpoint the characteristics that lead to improved revision outcomes.