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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.
Neurosurg Rev. 2019 Jun; 42(2):319-336.NR

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.

Authors+Show Affiliations

School of Medicine, Queen's University, Kingston, ON, Canada.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. tamir.ailon@vch.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29411177

Citation

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." Neurosurgical Review, vol. 42, no. 2, 2019, pp. 319-336.
How NE, Street JT, Dvorak MF, 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. 2019;42(2):319-336.
How, N. E., Street, J. T., Dvorak, M. F., Fisher, C. G., Kwon, B. K., Paquette, S., Smith, J. S., Shaffrey, C. I., & 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. Neurosurgical Review, 42(2), 319-336. https://doi.org/10.1007/s10143-018-0951-3
How NE, 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. 2019;42(2):319-336. PubMed PMID: 29411177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. AU - How,Nathan E, AU - Street,John T, AU - Dvorak,Marcel F, AU - Fisher,Charles G, AU - Kwon,Brian K, AU - Paquette,Scott, AU - Smith,Justin S, AU - Shaffrey,Christopher I, AU - Ailon,Tamir, Y1 - 2018/02/06/ PY - 2017/11/29/received PY - 2018/01/25/accepted PY - 2018/01/18/revised PY - 2018/2/8/pubmed PY - 2019/9/4/medline PY - 2018/2/8/entrez KW - Pseudarthrosis KW - Scoliosis KW - Spinal Fusion KW - Spine curvature KW - Surgical complication SP - 319 EP - 336 JF - Neurosurgical review JO - Neurosurg Rev VL - 42 IS - 2 N2 - 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. SN - 1437-2320 UR - https://www.unboundmedicine.com/medline/citation/29411177/Pseudarthrosis_in_adult_and_pediatric_spinal_deformity_surgery:_a_systematic_review_of_the_literature_and_meta_analysis_of_incidence_characteristics_and_risk_factors_ L2 - https://dx.doi.org/10.1007/s10143-018-0951-3 DB - PRIME DP - Unbound Medicine ER -