Chun Danielle S, Baker Kevin C, Hsu Wellington K
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and.
Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan.
Neurosurg Focus. 2015 Oct;39(4):E10. doi: 10.3171/2015.7.FOCUS15292.
OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I-III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.
目的 腰椎融合术失败导致的坚固性骨融合失败，即假关节形成，是腰椎融合术一种广为人知的并发症。放射成像技术、生物制剂、内固定器械、手术技术以及对局部生物学认识等方面的最新进展均有助于预防和治疗假关节形成。本文对目前有关腰椎假关节形成的诊断和治疗的文献进行综述。方法 使用MEDLINE和Embase数据库进行系统的文献综述，以检索文献（1985年至今）中发表的当前放射学诊断和手术治疗方法。纳入标准包括：1）英文发表；2）证据级别为I-III级；3）退行性腰椎疾病诊断和/或腰椎融合手术史；4）两种不同手术技术的对比研究或成像方式与手术探查的对比研究。结果 七项研究符合用于诊断腰椎假关节形成的当前放射成像的纳入标准。X线平片和薄层CT扫描是最常用的放射学诊断方法。正电子发射断层扫描（PET）已被证明是监测体内活性骨形成的有效成像方式。八项研究比较了处理和预防腰椎融合失败的手术技术。使用坚固的内固定器械可提高假关节形成的治疗成功率。结论 由于生物制剂、内固定器械、手术技术以及对局部生物学认识方面的进展，脊柱融合率有所提高。腰椎假关节形成的治疗包括多种手术选择，如更换松动的内固定器械、使用更有效的生物制剂以及椎间融合技术。预防和识别是脊柱假关节形成管理流程中的重要原则。
