Define nonunion following a spinal fusion procedure

Nonunion or pseudarthrosis is defined as the failure of an attempted fusion to heal within 1 year after surgery.

Table 24-1. Anterior Column Reconstruction Options after Corpectomy

GRAFT OPTIONS

ADVANTAGES

DISADVANTAGES

Autograft—iliac crest

Combination of cancellous bone (promotes osseous union) and cortical bone (provides structural support)

Low initial strength Curved geometry Donor site morbidity

Autograft—fibula

Straight geometry High initial strength

Cortical bone

Slow osseous incorporation Donor site morbidity

Autograft—rib

Can be harvested during surgical exposure

Low initial strength precludes use as a structural graft

Allograft—structural (e.g. femur, tibia)

High initial strength No donor site morbidity Versatile

Can be filled with autograft

Slow osseous incorporation Low risk of disease transmission

Vascular graft—rib

Relative ease of harvest Rapid healing even in compromised fusion bed

Low initial strength Use of adjunctive structural support required

Vascular graft—fibula

High initial strength Straight geometry Rapid healing even in compromised fusion bed

Technical procedure Time-consuming Donor site morbidity

Bone cement (PMMA)

No donor morbidity Adequate resistance to compressive loading

Biologically inert

Finite lifespan

Late loosening and failure

Synthetic fusion cage

High strength No donor site morbidity Can be customized to fill any bony defect Serrations provide resistance to shear forces

Subsidence in osteopenic bone may be problematic Osseous integration uncertain Long-term follow-up indeterminate

PMMA, polymethylmethacrylate. From Devlin VJ, Pitt DD. The evolution of surgery of the anterior spinal column. Spine State Art Rev 1998;12:493-528.

PMMA, polymethylmethacrylate. From Devlin VJ, Pitt DD. The evolution of surgery of the anterior spinal column. Spine State Art Rev 1998;12:493-528.

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