title: Revision surgery for lumbar pseudarthrosis.
abstract: BACKGROUND
  Revision surgery for pseudarthrosis after a lumbar spinal fusion has unpredictable functional results.
  
  
  OBJECTIVE
  The aim of this study was to determine the clinical outcomes of revision surgery to fuse the pseudarthrosis site based on the two most common diagnoses (degenerative disc disease [DDD] vs. spondylolisthesis).
  
  
  METHODS
  Patients who had a revision surgery between 1995 and 2004 for lumbar pseudarthrosis after short segment lumbar spinal fusion were identified through the institution's Spine Center surgery database. A retrospective chart review of clinical, hospital, and anesthesia records was then performed.
  
  
  METHODS
  Sixty-six patients were included in the study (28 patients with DDD and 38 patients with spondylolisthesis). Inclusion criteria were a surgical diagnosis of pseudarthrosis with a prior fusion of one or two motion segments, minimum 24 months of follow-up, and a diagnosis of either symptomatic DDD or spondylolisthesis as the primary indication for the index fusion surgery.
  
  
  METHODS
  The Oswestry disability index (ODI) and a self-assessment questionnaire were used to evaluate clinical outcomes.
  
  
  METHODS
  A retrospective chart and radiographic review was performed. Statistical analysis was done using Student t test for ODI scores and chi-square test for discrete variables from the outcome questionnaires.
  
  
  RESULTS
  Follow-up radiographs were available for 64 patients (97%), and a fusion rate of 100% was found in both groups for the radiographs examined. The mean postoperative ODI score was 53.3 (30-84.4) for DDD patients and 37.2 (2.5-76) for the spondylolisthesis group (p<.01). Only 50% of the patients in the DDD group felt that their overall well-being had improved since the surgery. In the spondylolisthesis group, 64% of patients stated that their overall well-being had improved since their revision surgery.
  
  
  CONCLUSIONS
  The clinical outcomes after revision surgery for pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Dede
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Thuillier
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
authors.affiliation: Department of Neurological Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Serena S
authors.initials: SS
authors.lastname: Hu
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA. Electronic address: devirenv@orthosurg.ucsf.edu.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013168:Spondylolisthesis / Q000601:surgery; D016896:Treatment Outcome
keywords: Degenerative disc disease; Revision surgery; Spinal fusion; Spondylolisthesis