Does the presence of a nonunion after an attempted spinal fusion always cause symptoms

No. Although many patients who develop a nonunion report pain symptoms, this is not always the case. Fusion success does not always correlate with patient outcome. However, many studies support a strong positive correlation between successful arthrodesis and positive patient outcomes.

Key Points

1. Graft options for spinal arthrodesis include autograft bone, allograft bone, synthetics, and bone morphogenetic protein (BMPs).

2. Successful posterior fusion is dependent on meticulous preparation of the graft bed, decortication of the osseous elements, and application of sufficient and appropriate graft material.

3. Fusion cages are devices intended to provide structural support to the anterior spinal column following removal of an intervertebral disc or vertebral body.

Websites

Bone graft alternatives: http://www.knowyourback.org/Documents/bone_grafts.pdf

Bone graft substitutes: http://aatb.kma.net/aatb/files/ccLibraryFiles/Filename/000000000101/AA0Sbonegraftsubstitutes.pdf Lumbar pseudarthrosis: http://www.medscape.com/viewarticle/462180

BiBLiOGRAPHY

1. Boden SD. Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine 2002;27:S26-S31.

2. Buchowski JM, Liu G, Bunmaprasert T, et al. Anterior cervical fusion assessment: Surgical exploration versus radiographic evaluation. Spine 2008;33:1185-91.

3. Buttermann GR, Glazer PA, Hu SS, et al. Revision of failed lumbar fusions: Comparison of anterior autograft and allograft. Spine 1997;22:2748-55.

4. Fischgrund JS, Mackay M, Herkowitz HN, et al. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997;22:2807-12.

5. Glassman SD, Carreon LY, Djurasovic M, et al. RhBMP versus iliac crest bone graft for lumbar spine fusion: A randomized, controlled trial in patients over sixty years of age. Spine 2008;33:2843-49.

6. Pradhan BP, Tatsumi Rl, Gallina J, et al. Ketorolac and spinal fusion: Does the perioperative use of ketorolac really inhibit spine fusion? Spine 2008; 33:2079-82.

7. Sandhu HS, Grewal HS, Parvataneni H. Bone grafting for spinal fusion. Orthop Clin North Am 1999;30:685-98.

8. Yazici M, Asher MA. Freeze-dried allograft for posterior spinal fusion in patients with neuromuscular spinal deformities. Spine 1997;22:1467-71.

FDA Disclosure: The U.S. Food and Drug Administration (FDA) has approved the clinical use of rhBMP-2, marketed as InFUSEā„¢ Bone Graft, in anterior lumbar interbody fusion with rhBMP-2 on an absorbable collagen sponge carrier within specific titanium cages. Use of this product for an indication not in the approved or cleared labeling is considered "off-label use."

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