{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T16:38:34Z","timestamp":1793723914750,"version":"4.6.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004156","name":"Mahidol University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004156","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study presents a systematic literature review and meta-analysis of pseudarthrosis risk factors following lumbar fusion procedures. The odds ratio (OR) and 95% confidence interval (95% CI) were used for outcome measurements. The objective of this study was to identify the independent risk factors for pseudarthrosis after lumbar spinal fusion, which is crucial for mitigating morbidity and reoperation. Systematic searches in PubMed, Embase, and Scopus (1990\u2013July 2021) were conducted using specific terms. The inclusion criteria included prospective and retrospective cohorts and case\u2012control series reporting ORs with 95% CIs from multivariate analysis. The quality assessment utilized the Newcastle\u2013Ottawa scale. Meta-analysis, employing OR and 95% CI, assessed pseudarthrosis risk factors in lumbar fusion surgery, depicted in a forest plot. Of the 568 abstracts identified, 12 met the inclusion criteria (9 retrospective, 2006\u20132021). The 17 risk factors were categorized into clinical, radiographic, surgical, and bone turnover marker factors. The meta-analysis highlighted two significant clinical risk factors: age (95% CI 1.02\u20131.11; <jats:italic>p<\/jats:italic>\u2009=\u20090.005) and smoking (95% CI 1.68\u20135.44; <jats:italic>p<\/jats:italic>\u2009=\u20090.0002). The sole significant surgical risk factor was the number of fused levels (pooled OR 1.35; 95% CI 1.17\u20131.55; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). This study identified 17 risk factors for pseudarthrosis after lumbar fusion surgery, emphasizing age, smoking status, and the number of fusion levels. Prospective studies are warranted to explore additional risk factors and assess the impact of surgery and graft type.<\/jats:p>","DOI":"10.1186\/s12891-024-07531-w","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T12:02:01Z","timestamp":1717416121000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9470-4935","authenticated-orcid":false,"given":"Win","family":"Boonsirikamchai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7651-4196","authenticated-orcid":false,"given":"Sirichai","family":"Wilartratsami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0525-6390","authenticated-orcid":false,"given":"Monchai","family":"Ruangchainikom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0136-1046","authenticated-orcid":false,"given":"Ekkapoj","family":"Korwutthikulrangsri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-8888","authenticated-orcid":false,"given":"Sasima","family":"Tongsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9554-4259","authenticated-orcid":false,"given":"Panya","family":"Luksanapruksa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"issue":"8","key":"7531_CR1","first-page":"1107","volume":"17","author":"T Tsutsumimoto","year":"2008","unstructured":"Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. EurSpine J. 2008;17(8):1107\u201312.","journal-title":"EurSpine J"},{"issue":"6","key":"7531_CR2","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1016\/j.jos.2019.08.015","volume":"24","author":"Y Sakai","year":"2019","unstructured":"Sakai Y, Kaito T, Takenaka S, Yamashita T, Makino T, Hosogane N, et al. Complications after spinal fixation surgery for osteoporotic vertebral collapse with neurological deficits: Japan Association of Spine Surgeons with ambition multicenter study. J Orthop Sci. 2019;24(6):985\u201390.","journal-title":"J Orthop Sci"},{"issue":"2","key":"7531_CR3","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s11420-019-09732-9","volume":"16","author":"PB Derman","year":"2020","unstructured":"Derman PB, Singh K. Surgical strategies for the treatment of lumbar pseudarthrosis in degenerative spine surgery: a literature review and case study. HSS J. 2020;16(2):183\u20137.","journal-title":"HSS J"},{"issue":"8","key":"7531_CR4","doi-asserted-by":"publisher","first-page":"494","DOI":"10.5435\/00124635-200908000-00003","volume":"17","author":"NM Raizman","year":"2009","unstructured":"Raizman NM, O\u2019Brien JR, Poehling-Monaghan KL, Yu WD. Pseudarthrosis of the spine. J Am Acad Orthop Surg. 2009;17(8):494\u2013503.","journal-title":"J Am Acad Orthop Surg"},{"key":"7531_CR5","doi-asserted-by":"crossref","unstructured":"Nunna RS, Ostrov PB, Ansari D, Dettori JR, Godolias P, Elias E, et al. The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis. Global Spine J. 2022;12(3):526\u201339.","DOI":"10.1177\/21925682211046899"},{"issue":"20","key":"7531_CR6","doi-asserted-by":"publisher","first-page":"2608","DOI":"10.1097\/00007632-200010150-00011","volume":"25","author":"SD Glassman","year":"2000","unstructured":"Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine (Phila Pa 1976). 2000;25(20):2608\u201315.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"7531_CR7","doi-asserted-by":"publisher","first-page":"E206","DOI":"10.1097\/BRS.0b013e3181bfa518","volume":"35","author":"CS Lee","year":"2010","unstructured":"Lee CS, Chung SS, Choi SW, Yu JW, Sohn MS. Critical length of fusion requiring additional fixation to prevent nonunion of the lumbosacral junction. Spine (Phila Pa 1976). 2010;35(6):E206\u201311.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"7531_CR8","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3171\/2014.6.SPINE13488","volume":"21","author":"Y Gologorsky","year":"2014","unstructured":"Gologorsky Y, Skovrlj B, Steinberger J, Moore M, Arginteanu M, Moore F, et al. Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis: Clinical article. J Neurosurg Spine. 2014;21(4):601\u20137.","journal-title":"J Neurosurg Spine"},{"key":"7531_CR9","unstructured":"GA Wells BS, D O\u2019Connell, J Peterson, V Welch, M Losos, P Tugwell. The Newcastle\u2012Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available from: https:\/\/www.ohri.ca\/\/programs\/clinical_epidemiology\/oxford.Asp."},{"issue":"6","key":"7531_CR10","doi-asserted-by":"publisher","first-page":"507","DOI":"10.14444\/6068","volume":"13","author":"DA Hollern","year":"2019","unstructured":"Hollern DA, Woods BI, Shah NV, Schroeder GD, Kepler CK, Kurd MF, et al. Risk factors for pseudarthrosis after surgical site infection of the spine. Int J Spine Surg. 2019;13(6):507\u201314.","journal-title":"Int J Spine Surg"},{"issue":"8","key":"7531_CR11","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/01.bsd.0000211226.97178.b9","volume":"19","author":"K Suda","year":"2006","unstructured":"Suda K, Ito M, Abumi K, Haba H, Taneichi H, Kaneda K. Radiological risk factors for pseudoarthrosis and\/or instrument breakage after PLF with the pedicle screw system in isthmic spondylolisthesis. J Spinal Disord Tech. 2006;19(8):541\u20136.","journal-title":"J Spinal Disord Tech"},{"key":"7531_CR12","doi-asserted-by":"publisher","first-page":"e155","DOI":"10.1016\/j.wneu.2021.02.117","volume":"150","author":"B Otsuki","year":"2021","unstructured":"Otsuki B, Fujibayashi S, Tanida S, Shimizu T, Murata K, Matsuda S. Possible association of pedicle screw diameter on pseudoarthrosis rate aftertransforaminal lumbar interbody fusion. World Neurosurg. 2021;150:e155\u201361.","journal-title":"World Neurosurg"},{"issue":"21","key":"7531_CR13","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1097\/BRS.0000000000000527","volume":"39","author":"M Bydon","year":"2014","unstructured":"Bydon M, De la Garza-Ramos R, Abt NB, Gokaslan ZL, Wolinsky JP, Sciubba DM, et al. Impact of smoking on complication and pseudarthrosis rates after single- and 2-level posterolateral fusion of the lumbar spine. Spine (Phila Pa 1976). 2014;39(21):1765\u201370.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"7531_CR14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jocn.2014.08.023","volume":"22","author":"M Bydon","year":"2015","unstructured":"Bydon M, De La Garza-Ramos R, Abt NB, Macki M, Sciubba DM, Wolinsky JP, et al. Durotomy is associated with pseudoarthrosis following lumbar fusion. J Clin Neurosci. 2015;22(3):544\u20138.","journal-title":"J Clin Neurosci"},{"issue":"19","key":"7531_CR15","doi-asserted-by":"publisher","first-page":"E1197","DOI":"10.1097\/BRS.0b013e31825d26d7","volume":"37","author":"S Fujibayashi","year":"2012","unstructured":"Fujibayashi S, Takemoto M, Izeki M, Takahashi Y, Nakayama T, Neo M. Does the formation of vertebral endplate cysts predict nonunion after lumbar interbody fusion? Spine (Phila Pa 1976). 2012;37(19):E1197\u2013202.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"7531_CR16","doi-asserted-by":"publisher","first-page":"E29","DOI":"10.1097\/BRS.0000000000001995","volume":"43","author":"H Inose","year":"2018","unstructured":"Inose H, Yamada T, Mulati M, Hirai T, Ushio S, Yoshii T, et al. Bone turnover markers as a new predicting factor for nonunion after spinal fusion surgery. Spine (Phila Pa 1976). 2018;43(1):E29-e34.","journal-title":"Spine (Phila Pa 1976)"},{"key":"7531_CR17","doi-asserted-by":"crossref","unstructured":"Jung JM, Chung CK, Kim CH, Yang SH, Ko YS. Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion. Spine (Phila Pa 1976). 2021;46(18):E1006\u201313.","DOI":"10.1097\/BRS.0000000000003980"},{"issue":"1","key":"7531_CR18","doi-asserted-by":"publisher","first-page":"106","DOI":"10.31616\/asj.2019.0024","volume":"14","author":"T Konomi","year":"2020","unstructured":"Konomi T, Yasuda A, Fujiyoshi K, Yato Y, Asazuma T. Incidences and risk factors for postoperative non-union after posterior lumbar interbody fusion with closed-box titanium spacers. Asian Spine J. 2020;14(1):106\u201312.","journal-title":"Asian Spine J"},{"issue":"4","key":"7531_CR19","doi-asserted-by":"publisher","first-page":"270","DOI":"10.22603\/ssrr.2017-0096","volume":"2","author":"K Satake","year":"2018","unstructured":"Satake K, Kanemura T, Nakashima H, Ishikawa Y, Segi N, Ouchida J. Nonunion of transpsoas lateral lumbar interbody fusion using an allograft: clinical assessment and risk factors. Spine Sur Rel Res. 2018;2(4):270\u20137.","journal-title":"Spine Sur Rel Res"},{"key":"7531_CR20","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/j.wneu.2016.10.030","volume":"97","author":"M Macki","year":"2017","unstructured":"Macki M, Syeda S, Rajjoub KR, Kerezoudis P, Bydon A, Wolinsky JP, et al. The effect of smoking status on successful arthrodesis after lumbar instrumentation supplemented with rhBMP-2. World Neurosurg. 2017;97:459\u201364.","journal-title":"World Neurosurg"},{"key":"7531_CR21","doi-asserted-by":"publisher","first-page":"105407","DOI":"10.1016\/j.clineuro.2019.105407","volume":"184","author":"GX Lin","year":"2019","unstructured":"Lin GX, Kotheeranurak V, Zeng TH, Mahatthanatrakul A, Kim JS. A longitudinal investigation of the endplate cystic lesion effect on oblique lumbar interbody fusion. Clin Neurol Neurosurg. 2019;184:105407.","journal-title":"Clin Neurol Neurosurg"},{"issue":"2","key":"7531_CR22","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s10143-018-0951-3","volume":"42","author":"NE How","year":"2019","unstructured":"How NE, Street JT, Dvorak MF, Fisher CG, Kwon BK, Paquette S, 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\u201336.","journal-title":"Neurosurg Rev"},{"issue":"1","key":"7531_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12306-019-00634-x","volume":"104","author":"M Formica","year":"2020","unstructured":"Formica M, Vallerga D, Zanirato A, Cavagnaro L, Basso M, Divano S, et al. Fusion rate and influence of surgery-related factors in lumbar interbody arthrodesis for degenerative spine diseases: a meta-analysis and systematic review. Musculoskelet Surg. 2020;104(1):1\u201315.","journal-title":"Musculoskelet Surg"},{"key":"7531_CR24","doi-asserted-by":"publisher","first-page":"e194","DOI":"10.1016\/j.wneu.2018.08.026","volume":"120","author":"RC Hofler","year":"2018","unstructured":"Hofler RC, Swong K, Martin B, Wemhoff M, Jones GA. Risk of pseudoarthrosis after spinal fusion: analysis from the healthcare cost and utilization project. World Neurosurg. 2018;120:e194\u2013202.","journal-title":"World Neurosurg"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-07531-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-024-07531-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-07531-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T12:04:04Z","timestamp":1717416244000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-024-07531-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,3]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["7531"],"URL":"https:\/\/doi.org\/10.1186\/s12891-024-07531-w","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,3]]},"assertion":[{"value":"13 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"433"}}