{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:25:26Z","timestamp":1791307526667,"version":"4.3.1"},"reference-count":120,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I\u2013III; 3) diagnosis of degenerative lumbar spine conditions and\/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.7.focus15292","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E10","source":"Crossref","is-referenced-by-count":181,"title":["Lumbar pseudarthrosis: a review of current diagnosis and treatment"],"prefix":"10.3171","volume":"39","author":[{"given":"Danielle S.","family":"Chun","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wellington K.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15292","series-title":"J Neurosurg Spine","first-page":"153","article-title":"Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis: clinical article","volume":"21","author":"Adogwa","year":"2014"},{"key":"b2-focus15292","series-title":"J Spinal Disord","first-page":"197","article-title":"Accuracy of SPECT scanning in diagnosing pseu-doarthrosis: a prospective study","volume":"11","author":"Albert","year":"1998"},{"issue":"Suppl 3","key":"b3-focus15292","series-title":"Eur Spine J","first-page":"369","article-title":"Fusion rate following extreme lateral lumbar interbody fusion","volume":"24","author":"Berjano","year":"2015"},{"key":"b4-focus15292","series-title":"J Bone Joint Surg Am","first-page":"1882","article-title":"Radiation exposure from musculoskeletal computerized tomographic scans","volume":"91","author":"Biswas","year":"2009"},{"key":"b5-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1186","article-title":"Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions","volume":"18","author":"Blumenthal","year":"1993"},{"key":"b6-focus15292","series-title":"J Spinal Disord","first-page":"482","article-title":"The value of scintigraphy in the diagnosis of pseudarthrosis after spinal fusion surgery","volume":"12","author":"Bohnsack","year":"1999"},{"issue":"6 Suppl","key":"b7-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"S261","article-title":"Correlation of radiologic assessment of lumbar spine fusions with surgical exploration","volume":"16","author":"Brodsky","year":"1991"},{"key":"b8-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"942","article-title":"The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study","volume":"11","author":"Brown","year":"1986"},{"key":"b9-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1765","article-title":"Impact of smoking on complication and pseudarthrosis rates after single- and 2-level posterolateral fusion of the lumbar spine","volume":"39","author":"Bydon","year":"2014"},{"key":"b10-focus15292","series-title":"J Bone Joint Surg Am","first-page":"712","article-title":"Repair of a pseudarthrosis of the lumbar spine. A functional outcome study","volume":"78","author":"Carpenter","year":"1996"},{"key":"b11-focus15292","series-title":"J Neurosurg Spine","first-page":"23","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion status","volume":"21","author":"Choudhri","year":"2014"},{"key":"b12-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2674","article-title":"Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients","volume":"27","author":"Christensen","year":"2002"},{"key":"b13-focus15292","series-title":"J Bone Joint Surg Am","first-page":"302","article-title":"Pseudarthrosis in the lumbosacral spine","volume":"30A","author":"Cleveland","year":"1948"},{"key":"b14-focus15292","series-title":"Spine J","first-page":"977","article-title":"Revision surgery for lumbar pseudarthrosis","volume":"15","author":"Dede","year":"2015"},{"key":"b15-focus15292","series-title":"Acta Orthop Belg","first-page":"578","article-title":"Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years","volume":"70","author":"Dehoux","year":"2004"},{"key":"b16-focus15292","series-title":"Clin Orthop Relat Res","first-page":"113","article-title":"The nature of pseudarthrosis","volume":"59","author":"DePalma","year":"1968"},{"key":"b17-focus15292","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b18-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1190","article-title":"Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity","volume":"39","author":"Dickson","year":"2014"},{"key":"b19-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2807","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation","volume":"22","author":"Fischgrund","year":"1997"},{"key":"b20-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2683","article-title":"ISSLS prize winner: positron emission tomography and magnetic resonance imaging for monitoring interbody fusion with equine bone protein extract, recombinant human bone morphogenetic protein-2, and autograft","volume":"33","author":"Foldager","year":"2008"},{"key":"b21-focus15292","series-title":"Global Spine J","first-page":"102","article-title":"Does transforaminal lumbar interbody fusion have advantages over posterolateral lumbar fusion for degenerative spondylolisthesis?","volume":"5","author":"Fujimori","year":"2015"},{"key":"b22-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"463","article-title":"Prospective analysis of imaging prediction of pseudarthrosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation","volume":"36","author":"Ghiselli","year":"2011"},{"key":"b23-focus15292","series-title":"Spine J","first-page":"13","article-title":"Lumbar fusion outcomes stratified by specific diagnostic indication","volume":"9","author":"Glassman","year":"2009"},{"key":"b24-focus15292","series-title":"J Neurosurg Spine","first-page":"984","article-title":"The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion","volume":"21","author":"Gologorsky","year":"2014"},{"key":"b25-focus15292","series-title":"J Biomed Mater Res B Appl Biomater","first-page":"918","article-title":"Does longstanding nicotine exposure impair bone healing and osseointegration? An experimental study in rabbits","volume":"91","author":"Gotfredsen","year":"2009"},{"key":"b26-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1957","article-title":"Population-based trends in volumes and rates of ambulatory lumbar spine surgery","volume":"31","author":"Gray","year":"2006"},{"key":"b27-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1619","article-title":"Results of surgical treatment of painful adult scoliosis","volume":"19","author":"Grubb","year":"1994"},{"key":"b28-focus15292","series-title":"Spine J","first-page":"531","article-title":"Methods of evaluating lumbar and cervical fusion","volume":"14","author":"Gruskay","year":"2014"},{"key":"b29-focus15292","series-title":"Neurosurgery","first-page":"116","article-title":"Smoking and the human vertebral column: a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion","volume":"41","author":"Hadley","year":"1997"},{"issue":"8 Suppl","key":"b30-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"S449","article-title":"Classification of pseudarthroses of the lumbar spine","volume":"16","author":"Heggeness","year":"1991"},{"key":"b31-focus15292","series-title":"J Am Acad Orthop Surg","first-page":"123","article-title":"Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations","volume":"3","author":"Herkowitz","year":"1995"},{"key":"b32-focus15292","series-title":"Eur Spine J","first-page":"2022","article-title":"Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up","volume":"22","author":"H\u00f8y","year":"2013"},{"key":"b33-focus15292","series-title":"J Am Acad Orthop Surg","first-page":"151","article-title":"Radionuclide imaging in the diagnosis and management of orthopaedic disease","volume":"20","author":"Hsu","year":"2012"},{"key":"b34-focus15292","series-title":"Global Spine J","first-page":"239","article-title":"Improving the clinical evidence of bone graft substitute technology in lumbar spine surgery","volume":"2","author":"Hsu","year":"2012"},{"key":"b35-focus15292","series-title":"J Bone Joint Surg Am","first-page":"e82","article-title":"Radiographic changes in patients with pseudarthrosis after posterior lumbar interbody arthrodesis using carbon interbody cages: a prospective five-year study","volume":"96","author":"Kanemura","year":"2014"},{"key":"b36-focus15292","series-title":"J Spinal Disord Tech","first-page":"163","article-title":"Biologics in spine arthrodesis","volume":"28","author":"Kannan","year":"2015"},{"key":"b37-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2313","article-title":"Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation","volume":"20","author":"Kant","year":"1995"},{"key":"b38-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1351","article-title":"Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine","volume":"31","author":"Kim","year":"2006"},{"key":"b39-focus15292","series-title":"J Bone Joint Surg Am","first-page":"721","article-title":"Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis","volume":"88","author":"Kim","year":"2006"},{"key":"b40-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"726","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis","volume":"29","author":"Kornblum","year":"2004"},{"key":"b41-focus15292","series-title":"Spine Surgery Basics","first-page":"533","article-title":"Complications: pseudoarthrosis\/nonunion","author":"Kullar","year":"2014"},{"key":"b42-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"210","article-title":"Low-back pain after lumbar fusion. Surgical and computed tomographic analysis","volume":"14","author":"Laasonen","year":"1989"},{"key":"b43-focus15292","series-title":"Rofo","first-page":"524","article-title":"3-dimensional computed tomography and multiplanar CT-reformations in lumbar spondylodesis","volume":"148","author":"Lang","year":"1988"},{"key":"b44-focus15292","series-title":"J Am Acad Orthop Surg","first-page":"153","article-title":"Pseudarthrosis of the lumbar spine","volume":"5","author":"Larsen","year":"1997"},{"key":"b45-focus15292","series-title":"J Spinal Disord","first-page":"117","article-title":"Assessment of pseudarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, flexion\/extension radiographs, CT scanning, and bone scintigraphy with operative findings","volume":"9","author":"Larsen","year":"1996"},{"key":"b46-focus15292","series-title":"Semin Spine Surg","first-page":"275","article-title":"Lumbar pseudarthrosis: diagnosis and treatment","volume":"23","author":"Lee","year":"2011"},{"key":"b47-focus15292","series-title":"Eur Spine J","first-page":"567","article-title":"Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion","volume":"12","author":"Madan","year":"2003"},{"issue":"20 Suppl","key":"b48-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2256S","article-title":"Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970\u20131993","volume":"19","author":"Mardjetko","year":"1994"},{"key":"b49-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"320","article-title":"Symposium: a critical discrepancy-a criteria of successful arthrodesis following interbody spinal fusions","volume":"26","author":"McAfee","year":"2001"},{"key":"b50-focus15292","series-title":"J Bone Joint Surg Br","first-page":"65","article-title":"The scintigraphic assessment of the scoliotic spine after fusion","volume":"62-B","author":"McMaster","year":"1980"},{"key":"b51-focus15292","series-title":"J Neurosurg Spine","first-page":"67","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion","volume":"21","author":"Mummaneni","year":"2014"},{"key":"b52-focus15292","series-title":"J Am Acad Orthop Surg","first-page":"494","article-title":"Pseudarthrosis of the spine","volume":"17","author":"Raizman","year":"2009"},{"key":"b53-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"430","article-title":"Spine computed tomography doses and cancer induction","volume":"35","author":"Richards","year":"2010"},{"key":"b54-focus15292","series-title":"J Bone Miner Metab","first-page":"555","article-title":"Nicotine modulates bone metabolism-associated gene expression in osteoblast cells","volume":"27","author":"Rothem","year":"2009"},{"key":"b55-focus15292","series-title":"Neurosurgery","first-page":"368","article-title":"Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients","volume":"54","author":"Salehi","year":"2004"},{"key":"b56-focus15292","series-title":"Eur Spine J","first-page":"378","article-title":"Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation","volume":"12","author":"Shah","year":"2003"},{"key":"b57-focus15292","series-title":"J Bone Joint Surg Am","first-page":"756","article-title":"Anterior interbody lumbar spine fusion. Analysis of Mayo Clinic series","volume":"54","author":"Stauffer","year":"1972"},{"key":"b58-focus15292","series-title":"J Spinal Disord Tech","first-page":"362","article-title":"Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months","volume":"25","author":"Strube","year":"2012"},{"key":"b59-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1207","article-title":"Low back pain hospitalization. Recent United States trends and regional variations","volume":"19","author":"Taylor","year":"1994"},{"key":"b60-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"983","article-title":"A prospective, randomized study of lumbar fusion. Preliminary results","volume":"18","author":"Zdeblick","year":"1993"},{"key":"b1-focus15292","series-title":"J Neurosurg Spine","first-page":"153","article-title":"Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis: clinical article","volume":"21","author":"Adogwa","year":"2014"},{"key":"b2-focus15292","series-title":"J Spinal Disord","first-page":"197","article-title":"Accuracy of SPECT scanning in diagnosing pseu-doarthrosis: a prospective study","volume":"11","author":"Albert","year":"1998"},{"issue":"Suppl 3","key":"b3-focus15292","series-title":"Eur Spine J","first-page":"369","article-title":"Fusion rate following extreme lateral lumbar interbody fusion","volume":"24","author":"Berjano","year":"2015"},{"key":"b4-focus15292","series-title":"J Bone Joint Surg Am","first-page":"1882","article-title":"Radiation exposure from musculoskeletal computerized tomographic scans","volume":"91","author":"Biswas","year":"2009"},{"key":"b5-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1186","article-title":"Can lumbar spine radiographs accurately determine fusion in postoperative patients? 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A functional outcome study","volume":"78","author":"Carpenter","year":"1996"},{"key":"b11-focus15292","series-title":"J Neurosurg Spine","first-page":"23","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion status","volume":"21","author":"Choudhri","year":"2014"},{"key":"b12-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2674","article-title":"Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients","volume":"27","author":"Christensen","year":"2002"},{"key":"b13-focus15292","series-title":"J Bone Joint Surg Am","first-page":"302","article-title":"Pseudarthrosis in the lumbosacral spine","volume":"30A","author":"Cleveland","year":"1948"},{"key":"b14-focus15292","series-title":"Spine J","first-page":"977","article-title":"Revision surgery for lumbar pseudarthrosis","volume":"15","author":"Dede","year":"2015"},{"key":"b15-focus15292","series-title":"Acta Orthop Belg","first-page":"578","article-title":"Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years","volume":"70","author":"Dehoux","year":"2004"},{"key":"b16-focus15292","series-title":"Clin Orthop Relat Res","first-page":"113","article-title":"The nature of pseudarthrosis","volume":"59","author":"DePalma","year":"1968"},{"key":"b17-focus15292","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b18-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"1190","article-title":"Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity","volume":"39","author":"Dickson","year":"2014"},{"key":"b19-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2807","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation","volume":"22","author":"Fischgrund","year":"1997"},{"key":"b20-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"2683","article-title":"ISSLS prize winner: positron emission tomography and magnetic resonance imaging for monitoring interbody fusion with equine bone protein extract, recombinant human bone morphogenetic protein-2, and autograft","volume":"33","author":"Foldager","year":"2008"},{"key":"b21-focus15292","series-title":"Global Spine J","first-page":"102","article-title":"Does transforaminal lumbar interbody fusion have advantages over posterolateral lumbar fusion for degenerative spondylolisthesis?","volume":"5","author":"Fujimori","year":"2015"},{"key":"b22-focus15292","series-title":"Spine (Phila Pa 1976)","first-page":"463","article-title":"Prospective analysis of imaging prediction of pseudarthrosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation","volume":"36","author":"Ghiselli","year":"2011"},{"key":"b23-focus15292","series-title":"Spine J","first-page":"13","article-title":"Lumbar fusion outcomes stratified by specific diagnostic indication","volume":"9","author":"Glassman","year":"2009"},{"key":"b24-focus15292","series-title":"J Neurosurg Spine","first-page":"984","article-title":"The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion","volume":"21","author":"Gologorsky","year":"2014"},{"key":"b25-focus15292","series-title":"J Biomed Mater Res B Appl Biomater","first-page":"918","article-title":"Does longstanding nicotine exposure impair bone healing and osseointegration? 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