Failed Spinal Fusion | Nonunion | Pseudoarthrosis

What is a failed spinal fusion?

Most of the time, spinal fusion surgery goes well and the bones heal as they should. But sometimes, things don’t go as planned and the bones don’t fuse properly and the patient continues to have severe pain. This is known as a failed spinal fusion or “nonunion” or pseudoarthrosis. Various factors can lead to this, such as the patient’s age, overall health, and the number of fused levels. Another complication of a failed spinal fusion is adjacent segment disease, where the spinal segments next to the fusion site start to degenerate, leading to discomfort and instability. Pseudoarthrosis is more common in the lumbosacral joint, the area between the lumbar and sacral spine in the lower back. Doctor Andre M. Samuel, orthopedic spine specialist, treats patients in the Clear Lake, Houston, Sugar Land, TX area with a failed spinal fusion.

What is Nonunion?

Nonunion is another term used for a failed spinal fusion. It occurs when the bones don’t heal and fuse properly after spinal fusion surgery. Dr. Samuel and his team consider this one of their top post-operative concerns. Older patients are at higher risk due to their reduced bone healing capacity. Smoking, being overweight, osteoporosis, other bone disorders, and infections at the surgical site also increase the chances of nonunion.

What are the symptoms of a failed spinal fusion?

Persistent or worsening pain is the most common symptom of a failed spinal fusion or nonunion. Other symptoms of pseudoarthrosis include:

• Pain radiating to the arms or legs
• Difficulty standing or walking
• Weakness or numbness in the limbs
• Limited mobility or range of motion

If you experience any of these symptoms after spinal fusion surgery, it’s important to consult Dr. Samuel and his team for further evaluation and treatment.

How is a failed spinal fusion diagnosed?

Diagnosing a failed spinal fusion or pseudoarthrosis is a multi-step process. First, Dr. Samuel examines a patient for pain, weakness, or limited mobility. Next, he’ll order imaging tests like X-rays, CT scans, or MRI scans to see if the bones have fused properly. These images can show any gaps or movement at the fusion site. A bone scan might be done to detect abnormal bone activity, which could indicate nonunion. Blood tests can also be helpful to identify any infections or underlying conditions that might affect how the bones heal. By combining these methods, Dr. Samuel can accurately diagnose a failed spinal fusion and suggest the best course of treatment.

How is a failed spinal fusion treated?

As with any condition, Dr. Samuel will recommend conservative, non-surgical treatments first to help relieve symptoms of a failed spinal fusion. These can include physical therapy to strengthen muscles and improve flexibility, pain management with medications, and bracing to stabilize the spine. Other options may include injections to reduce inflammation, bone stimulation devices to promote healing, and lifestyle changes like quitting smoking and losing weight.

If conservative therapies don’t help reduce pain and restore function, surgery may be the only option to reverse a non-union. Dr. Samuel offers several surgical options to treat a failed spinal fusion.

• Revision Surgery – Dr. Samuel performs the spinal fusion a second time to ensure the bones are aligned properly, and he might replace any existing hardware with new implants.
• Bone Graft – To stimulate bone growth and help the bones fuse correctly, bone grafts are added to the fusion site. Dr. Samuel can use your bone (autograft) or donor bone (allograft).
• Instrumentation: Additional metal rods, screws, or plates are used to support the spine and aid the bone fusion process.
• Decompression Surgery – Parts of the bone or soft tissue are removed to relieve pressure on the nerves.
• Osteotomy: Dr. Samuel may cut and realign the bones in the spine to correct any deformities, improving the chances of a successful fusion.

Not every procedure is right for every patient. Dr. Samuel recommends the best approach based on your condition, age, and overall health. He and his team will discuss the benefits and risks of each surgery with you beforehand. Ultimately, the decision to proceed with surgery is always yours.