PMID- 27853663 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220409 IS - 2192-5682 (Print) IS - 2192-5690 (Electronic) IS - 2192-5682 (Linking) VI - 6 IP - 8 DP - 2016 Dec TI - Impact of Surgical Approach on Clinical Outcomes in the Treatment of Lumbar Pseudarthrosis. PG - 786-791 AB - Study Design Retrospective comparative cohort. Objective Pseudarthrosis following fusion for degenerative lumbar spine pathologies remains a substantial problem. Current data shows that patients who develop a pseudarthrosis have suboptimal outcomes. This study evaluates if treatment of pseudarthrosis can be affected by surgical approach. Methods Medical records of 63 female and 65 male patients (mean age 50.37) who were treated for nonunion following lumbar fusion were reviewed. Sixty patients underwent posterolateral fusion (PSF), 18 underwent PSF with transforaminal interbody fusion (TLIF), 32 underwent anterior and posterior spinal fusion (AP), and 24 underwent anterior lumbar interbody fusion (ALIF). Results Significant differences between the treatment groups were observed in length of stay (p = 0.000), blood loss (p = 0.000), and operative time (p = 0.000). In the AP fusion group, minimal clinically important difference (MCID) was reached in 47% of patients for back pain, 28% for leg pain, and 28% for Oswestry Disability Index (ODI). PSF had the highest percentage of patients reaching MCID for Short Form-36 (SF-36) physical composite score at 25%. ALIF and TLIF subgroups reached MCID for ODI in 17% of patients. Linear regression analysis showed that type of surgical approach did not impact change in ODI scores. Conclusion Although not statistically significant, the AP fusion group reached MCID more frequently in all outcomes except SF-36 Physical Component Summary. All surgical approaches examined for treatment of lumbar pseudarthrosis resulted in only poor to modest improvement in ODI. This result further emphasizes the importance of achieving a solid fusion with the index surgery. FAU - Owens, R Kirk 2nd AU - Owens RK 2nd AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. FAU - Djurasovic, Mladen AU - Djurasovic M AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. FAU - Crawford, Charles H 3rd AU - Crawford CH 3rd AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. FAU - Glassman, Steven D AU - Glassman SD AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. FAU - Dimar, John R 2nd AU - Dimar JR 2nd AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. FAU - Carreon, Leah Y AU - Carreon LY AD - Norton Leatherman Spine Center, Louisville, Kentucky, United States. LA - eng PT - Journal Article DEP - 20160406 PL - England TA - Global Spine J JT - Global spine journal JID - 101596156 PMC - PMC5110356 OTO - NOTNLM OT - lumbar fusion OT - nonunion OT - outcomes OT - revision spine surgery OT - surgical approach COIS- Disclosures R. Kirk Owens II: Employee of Norton Healthcare; receives payments for lectures from Alphatec. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. Mladen Djurasovic: Employee of Norton Healthcare; receives consulting fees from Medtronic. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. Charles H. Crawford III: Employee of Norton Healthcare and the University of Louisville School of Medicine; receives consulting fees from Alphatec and Medtronic; received research grants from National Institutes of Health, Orthopedic Research and Education Fund, and Norton Healthcare; receives payments for lectures from DePuy Synthes; receives funds for travel and accommodation from the North American Spine Society and the Scoliosis Research Society. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. Steven D. Glassman: Employee of Norton Healthcare; received research grants from Norton Healthcare; holds patents from and receives royalties from Medtronic. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's Institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. John R. Dimar II: Employee of Norton Healthcare; board member, Scoliosis Research Society; receives consulting fees from Medtronic and DePuy; receives payments for lectures from Medtronic, DePuy, and Norton Healthcare; holds patents from and receives royalties from Medtronic; is on the editorial review board of JBJS Highlights, Spine, Spine Deformity, Journal of the American Academy of Orthopaedic Surgeons, and Global Spine Journal. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. Leah Y. Carreon: Employee of Norton Healthcare; member, Editorial Advisory Board, Spine and Spine Journal; Institutional Review Board member, University of Louisville Institutional Review Board; Global Evidence Advisory Board member, Medtronic 2012, 2013; Research Committee member, Scoliosis Research Society; received research grants from Norton Healthcare and AO Spine paid directly to Scoliosis Research Society 2010 to 2011; receives research funds from the Orthopedic Research and Educational Fund, 2013 to present; received research grant from Norton Healthcare, 2013; receives Scoliosis Research Society Research Funding, 2013 to present; received research funding from the Norton Healthcare James R. Petersdorf Fund, 2015; received funds for travel for Study Planning Meetings from Orthopedic Educational Research Fund, Department of Defense, Association for Collaborative Spine Research, and the Center for Spine Surgery and Research of the University of Southern Denmark; received funds for travel for Annual required Continuing Education for Institutional Review Board members, University of Louisville Institutional Review Board; honoraria for participation in Review Panels National Institutes of Health, Children's Tumor Foundation, and Global Evidence Advisory Board, Medtronic. Medtronic provided funds directly to database company. No funds were paid directly to individual or individual's institution January 2002 to September 2009. Nuvasive provided funds directly to database company. No funds were paid directly to individual or individual's institution June 2012 to April 2015. EDAT- 2016/11/18 06:00 MHDA- 2016/11/18 06:01 PMCR- 2016/12/01 CRDT- 2016/11/18 06:00 PHST- 2016/01/01 00:00 [received] PHST- 2016/02/25 00:00 [accepted] PHST- 2016/11/18 06:00 [entrez] PHST- 2016/11/18 06:00 [pubmed] PHST- 2016/11/18 06:01 [medline] PHST- 2016/12/01 00:00 [pmc-release] AID - 1600010 [pii] AID - 10.1055/s-0036-1582390 [doi] PST - ppublish SO - Global Spine J. 2016 Dec;6(8):786-791. doi: 10.1055/s-0036-1582390. Epub 2016 Apr 6.