Pseudarthrosis at L5-S1 after Posterolateral Lumbar Fusion

ABSTRACT

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to investigate the rate of pseudarthrosis at L5-S1 after posterolateral fusion only for degenerative lumbar spinal disease, and to determine the radiological findings that help diagnose pseudarthrosis. SUMMARY OF THE LITERATURE REVIEW The pseudarthrosis rate at L5-S1 is much higher than that at the other lumbar segments. However, there have been few studies for the rate and risk factors of pseudarthrosis at L5-S1. MATERIALS AND METHODS: A total of 88 patients who underwent pedicle screw instrumentation and posterolateral lumbar fusion were evaluated with a minimum of 1-year follow up. Bony union was evaluated by the bony fusion mass, the angulation on the flexion-extension radiographs and the radiolucent zone around the pedicle screws. The patients' age, bony mineral density, the number of fused segments and lumbar lordosis were evaluated for their association with pseudarthrosis at L5-S1. RESULTS: Pseudarthrosis developed in 22 patients at L5-S1 and in 8 patients at other levels. The change of angulation on the flexion-extension radiographs at the last follow-up was 5.2degrees in the pseudarthrosis group and 1.7degrees in the fusion group (P=0.3). A radiolucent zone of the sacral screws was noted in 10 patients; in 7 of the 22 patients in the pseudarthrosis group and in 3 of the 66 patients in the fusion group. The average age, the mean number of levels fused and the bone mineral density were similar in both groups. Lumbar lordosis was not associated with the development of pseudarthrosis at L5-S1. CONCLUSION: The pseudarthrosis rate was significantly higher at L5-S1 than that at the other lumbar segments following instrumented posterolateral fusion. Pseudarthrosis was closely related to hypermobile angulation (> or =5degrees) on the flexion-extension radiographs and a radiolucent zone around the sacral screws.