This 2009 JAAOS review examines the diagnosis, risk factors, and surgical management of spinal pseudarthrosis — failed fusion diagnosed ≥1 year after index surgery. It synthesizes evidence on imaging modalities, instrumentation choices, graft selection, osteobiologics, and revision strategies for both cervical and lumbar nonunion.
When a patient has persistent axial or radicular pain after spinal fusion, pursue thin-cut CT (not plain films alone) for fusion assessment, and counsel smokers that their nonunion risk is five times higher — cessation is a prerequisite for revision surgery optimization.
For failed anterior cervical fusion, posterior revision offers dramatically lower re-failure rates than repeat anterior surgery.
This 2009 JAAOS review examines the diagnosis, risk factors, and surgical management of spinal pseudarthrosis — failed fusion diagnosed ≥1 year after index surgery. It synthesizes evidence on imaging modalities, instrumentation choices, graft selection, osteobiologics, and revision strategies for both cervical and lumbar nonunion.
When a patient has persistent axial or radicular pain after spinal fusion, pursue thin-cut CT (not plain films alone) for fusion assessment, and counsel smokers that their nonunion risk is five times higher — cessation is a prerequisite for revision surgery optimization.
For failed anterior cervical fusion, posterior revision offers dramatically lower re-failure rates than repeat anterior surgery.