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Lumbar 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.

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.

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

Symptoms from a lumbar pseudoarthrosis can vary depending on how much motion is left at the spinal segment which was surgically treated.

Patients often have ongoing low-back 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. Low back pain
  2. Low back spasms
  3. Feeling that the spine is not stable
  4. Pain in the hips and buttocks
  5. Leg pain, numbness, or weakness

How is a Lumbar 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 diagnosis of a pseudoarthrosis. CT technology can show the bone anatomy in much more detail than plain X-Rays. It will show the fusion area and if bone has grown across the fusion.

     3. MRI

MRI scans can be helpful in evaluating the spine for a pseudoarthrosis, but are not as good as CT scans to evaluate the bone itself.

     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 Lumbar Pseudoarthrosis?

Here are some treatment options for this condition:

  1. Non-Surgical Care

A. 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.

B. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

C. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

D. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

E. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

F. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments.

G. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

H. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Nerve Pain Medications
  4. Antidepressants
  5. Topical Medications

 

I. Spinal Injections

Here are some possible spinal injections which can be offered for this condition:

1. Lumbar Interlaminar Epidural Steroid Injection

2. Caudal Epidural Steroid Injection

3. Lumbar Facet Joint Injection

4. Lumbar Facet Joint Radiofrequency Rhizotomy

 

J. Implanted Devices for Pain Relief

For patients who have no surgical options and have failed other more conservative types of spine care, the following Implanted Devices for Pain Relief are available:

Lumbar Spine Cord Stimulation Device

Lumbar Implanted Pain Pump

 

2. Surgical Care

If a patient continues to suffer from significant symptoms from a lumbar pseudoarthrosis, a revision surgery can often be offered. A revision surgery is a surgical attempt to complete the fusion. The surgeon often changes the technique of the first fusion and may add special implants or materials to the spine to make a fusion more likely.

Here is a surgical procedure done for a Pseudoarthrosis:

  1. Lumbar Fusion (Repeat)