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Cervical Pseudoarthrosis

What does Pseudoarthrosis mean?

The word pseudoarthrosis of the spine comes from the Greek words “pseu” meaning “false” and “arthrosis” meaning “joint”. A “false joint” of the spine is an area of the spine which was surgically treated to form bone, but never healed completely. In other wordsthe bones never mended together to form a fusion.

What is a Pseudoarthrosis?

The most common example of a pseudoarthrosis is an attempted surgical fusion of the spine which failed to heal.

It can often take 6 months to 1 year for a surgical fusion to complete itself. However, after the expected time interval has passed without any evidence that a fusion has happened, the diagnosis of a pseudoarthrosis is often made. Patients with a pseudoarthrosis can have ongoing symptoms such as chronic neck pain.

Who is at a higher risk do develop a Spinal Pseudoarthrosis?

Patients at risk for a pseudoarthrosis are the following:

  1. Smokers
  2. Diabetics
  3. Patients with Osteoporosis
  4. Patients with poor immune systems
  5. Patients who do not follow the recommendations for restrictions on their activity after a fusion surgery
  6. Patients who have diseases affecting bone healing

What are the symptoms of a Spinal Pseudoarthrosis?

Symptoms from a pseudoarthrosis can vary depending on how much motion is left at the spinal segment which was surgically treated. Patients often have ongoing spine pain after the fusion should have already healed. Not all patients who develop a pseudoarthrosis will have pain.

Here are some of the symptoms patients may experience:

  1. Neck pain
  2. Neck stiffness
  3. Neck spasms
  4. Pain radiating to the shoulders
  5. Feeling of instability in the neck
  6. Pain, numbness, or weakness in the arms

How is a Spinal Pseudoarthrosis diagnosed?

The diagnosis of a pseudoarthrosis is made with imaging studies.

  1. X-Rays

When looking for a pseudoarthrosis, X-Rays of the Spine are often taken with the patient bending forward and backwards (flexion/extension). The motion at the spine segment can then be measured or observed. While sometimes an X-Ray can show the failed fusion clearly, it can also be insufficient to make the diagnosis of a pseudoarthrosis.

      2. CT-Scans

CT scans of the spine are the study of choice to make a definite diagnosis of a pseudoarthrosis if an X-Ray is not clear. CT technology can show the bone anatomy in much more detail than plain X-Rays.

      3. MRI

MRI scans can be helpful in evaluating the spine for a pseudoarthrosis, but are not as good as an X-Ray or CT scan to evaluate the bone itself.4.

      4. Nuclear Bone Scans

Nuclear bone scans can show the activity at a pseudoarthrosis which comes from continued motion where there should be none or very little. This results in nuclear bone scan images showing areas of activity (hot areas) which can point to a pseudoarthrosis.

What is the treatment of a Spinal Pseudoarthrosis?

Not all cases of a Pseudoarthrosis need surgery to repair them. Some fusion segments can be quite stable even if a full bone fusion has not developed. Some spine specialists call this a “soft fusion”.

Here are some treatment options for a Spinal Pseudoarthrosis:

  1. Bone stimulators

These are devices which send electrical impulses to the spine to stimulated bone to grow. They can be placed over the skin of the spine segment or surgically implanted.

      2. Revision Surgery

If a patient continues to suffer from significant symptoms from a pseudoarthrosis, a revision surgery can often be offered. A revision surgery is a surgical attempt to complete the fusion.

 Here are some surgical procedures performed for a Spinal Pseudoarthrosis:

  1. Anterior Cervical Decompression and Fusion (ACDF)
  2. Posterior Cervical Fusion
  3. Cervical Artificial Disc Replacement. Even though Artificial Disc Replacements were not specifically intended for this scenario, some spine surgeons consider this to be an option in selected patients.