Pseudoarthrosis

The symptoms of pseudoarthrosis can vary depending on the location and severity of the nonunion. Common symptoms include:

• Pain: Persistent pain at the site of the surgery that does not improve over time.
• Instability: A feeling of instability or abnormal movement at the surgical site.
• Deformity: Visible deformity or abnormal alignment
• Swelling: Swelling and tenderness at the site
• Functional Impairment: Reduced range of motion and impaired function.

Pseudoarthrosis, or nonunion of an attempted spinal fusion, can be caused by several factors. Understanding the specific cause of pseudoarthrosis in a patient is crucial for determining the most appropriate treatment approach. Factors can broadly be categorized into biological, mechanical, and patient-related causes.

Biological Factors

• Inadequate Blood Supply: Insufficient blood flow to the site can impair healing.
• Infection: An infection at the site can prevent proper healing, leading to nonunion.
• Poor Nutrition: Nutritional deficiencies, particularly calcium and vitamin D, can impair bone healing.
• Smoking: Smoking has been shown to negatively affect bone healing due to its impact on blood flow and the overall biological environment.

Mechanical Factors

• Inadequate Stabilization: Insufficient immobilization or stabilization of the fracture can result in abnormal movement at the site, preventing proper healing.
• Hardware Failure: In cases where surgical fixation is used, failure of the hardware (such as screws or plates) can lead to nonunion.
• Excessive Motion: Excessive motion at the fracture site, often due to inadequate immobilization or premature activity, can interfere with the healing process.

Patient-Related Factors

• Age: Older patients often have a slower healing process due to decreased bone density and other age-related factors.
• Medical Conditions: Conditions such as diabetes, osteoporosis, and certain hormonal disorders can impair bone healing.
• Medications: Some medications, such as corticosteroids, can interfere with bone healing.
• Lifestyle Factors: Factors such as alcohol consumption and lack of physical activity can also affect bone healing.

Diagnosing pseudoarthrosis involves a combination of clinical evaluation and imaging studies:

Dr. Colman will review the patient’s medical history and perform a physical examination to assess the symptoms and check for signs of nonunion. Imaging involves:

• Standard X-rays are usually the first imaging test to identify the presence of a nonunion. They can show the gap or abnormal movement at the operative site.
• A CT scan provides a more detailed view of the bone structure and can help to confirm the diagnosis and assess the extent of the nonunion.
• An MRI can evaluate the soft tissues surrounding the fracture site and detect any associated complications such as infection or bone necrosis.
• A bone scan can help to determine the activity of bone healing and identify areas of increased bone metabolism.
• A DEXA scan can diagnose a bone-health issue or osteoporosis

The treatment of pseudoarthrosis aims to promote bone healing, restore stability, and alleviate pain. Treatment options include:

Non-surgical Treatments

• Immobilization: Prolonged immobilization with a brace can sometimes encourage healing.
• Bone Stimulation: Indirect bone stimulation with electrical or ultrasound bone stimulators can be used to promote bone growth and healing. Pulsed Electromagnetic Field (PEMF) devices generate electromagnetic fields that are applied to the nonunion site to promote healing.
• Medications: Pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics.

Surgical Treatment

• Bone grafting: Autologous (from the patient) or allogenic (from a donor) bone grafts are used to stimulate bone healing and bridge the gap at the fracture site.
• Internal Fixation: Metal plates, screws, rods, or nails are used to stabilize the fracture and hold the bone in place to promote healing.
• Direct Electrical stimulation: Electrodes are implanted near the nonunion site to deliver continuous electrical currents, which can stimulate bone healing.
• Bone Morphogenetic Proteins (BMPs): BMPs are growth factors that can be applied to the nonunion site to stimulate bone formation. They are often used in conjunction with bone grafting.

Following surgery, a comprehensive rehabilitation program is essential to ensure proper healing and restore function. This may include physical therapy, pain management, and regular follow-up appointments to monitor progress.