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A histologic study of lumbar pseudarthrosis
M H Heggeness1, S I Esses, D R Mody
1Baylor College of Medicine, Center for Spinal Disorders, Houston, Texas.
Spine
|June 15, 1993
Summary
Pseudarthrosis repair after spinal fusion failure reveals fibrous tissue and bone resorption at motion sites. Facet joints show degenerative changes, including cartilage damage and sclerosis.
Area of Science:
- Spine surgery
- Orthopedic pathology
Background:
- Pseudarthrosis, or failed spinal fusion, is a common complication following posterior spinal fusions.
- Understanding the biological environment at the non-union site is crucial for improving revision strategies.
Purpose of the Study:
- To histologically characterize the tissue found at pseudarthrosis sites after failed posterior spinal fusions.
- To evaluate the condition of the lumbar facet joints in these patients.
Main Methods:
- Biopsy specimens were obtained from 35 patients undergoing pseudarthrosis repair.
- Tissues were sampled from the fusion mass, areas of motion, and lumbar facet remnants.
- Histological analysis focused on tissue composition, bone morphology, and facet joint pathology.
Main Results:
- Fibrous tissue with fibrocartilaginous metaplasia and bone resorption was prevalent between adjacent bony segments.
- Bone adjacent to motion sites exhibited sclerosis, poor organization, and microtrabecular fractures with new bone formation.
- Facet joint biopsies consistently showed degenerative changes, including cartilage fissuring, chondrocyte cloning, and subchondral sclerosis.
Conclusions:
- Pseudarthrosis sites are characterized by active biological processes including fibrous tissue ingrowth and bone remodeling.
- Facet joint degeneration is a common comorbidity in patients with failed spinal fusions.
- These findings highlight the complex pathology at non-union sites and adjacent structures.