Spinal fusion is a well-established procedure designed to stabilize the spine and relieve chronic pain and/or help regain loss of function and sensation by fusing two or more vertebrae. While most patients experience significant improvement, a complication known as pseudarthrosis or a false joint can form. This is when two or more bones fail to fuse, which can result in continued pain and instability.
If you've undergone spinal fusion and are still living with pain or limited mobility, you may be facing this exact challenge. Dr. Jeremy Smith, a board-certified orthopaedic spine surgeon, specializes in addressing complex cases of failed fusion through revision surgery, helping patients regain stability and improve their quality of life.
Understanding Pseudarthrosis
What Is Pseudarthrosis?
Pseudarthrosis occurs when a spinal fusion doesn't heal properly, resulting in movement at the surgical site where the bones were meant to fuse. Instead of a solid, stable connection, a false joint develops—hence the term. A pseudoarthrosis does not always result in pain. This failed union can cause persistent discomfort, weakness, loss of function and/or sensation, and other neurological symptoms depending on the location of the fusion and affected nerves.
Why Spinal Fusions Fail
Spinal fusion is a technically demanding procedure, and several factors can compromise its success:
Patient-related factors
- Smoking: Nicotine significantly impairs bone healing by slowing the production of vital bone-forming cells (osteoclasts), and decreasing the absorption of calcium which can result in low bone density.
- Obesity: Excess body weight puts added mechanical stress on the spine, making it harder for fusion to succeed.
- Chronic medical conditions: Diabetes and other systemic illnesses can delay healing of bone and a higher risk for infection due to a weakened immune system.
Surgical factors
- Inadequate stabilization: Hardware that doesn’t properly immobilize the spine may allow micro-movements that prevent fusion.
- Surgical technique: Precision in placement, alignment, and bone grafting is essential. Missteps can lead to nonunion.
Biological and medication-related factors
- Osteoporosis: Weakened bone structure can’t always support proper fusion.
- Infections: Even low-grade infections can disrupt the healing process.
- Corticosteroids: Long-term use affects bone metabolism and fusion capability.
Symptoms of Pseudarthrosis
Many patients with pseudarthrosis continue to experience:
- Pain at the original surgical site
- A sensation of instability or unusual movement in the back or neck
- Neurological symptoms such as numbness, tingling, or weakness if nerves are affected
Pseudarthrosis Revision Surgery
Goals of Revision Surgery
The main goals of pseudarthrosis revision are straightforward—but achieving them requires expert hands:
- Establish solid bone fusion
- Stabilize the spinal segment
- Reduce pain
- Restore mobility, function and sensation of affected areas
Surgical Approach
Dr. Smith tailors the surgical approach based on the location of the failed fusion and the method used in the original surgery in correlation to the patient’s symptoms and lifestyle. This ensures that the patient has a custom surgical plan that fits their needs. A combined anterior-posterior approach may be necessary for more complex cases.
Key Steps in Revision Surgery
To identify the best surgical plan and previous surgical issues, common imaging studies used are:
- X-rays: with anterior-posterior, lateral, flexion and extension views. This is the first step to visualize the previous fusion and any movement of the fused area.
- MRI: identifies compressive pathology and infections. Metal artifacts can be an issue with this study and can depend on how extensive the previous fusion was and what material was used.
- CT Myelogram (Computed Tomography Myelogram): an alternative to the MRI to visualize compressive pathology and infection. This imaging study is more invasive and is generally reserved if the MRI is inconclusive due to a metal artifact or the patient is unable to complete an MRI due to medical reasons.
- CT (Computed Tomography Scan): visualizes the hardware integrity, and bony defects that may encroach the affected nerves.
- SPECT CT (Single Photon Emission Computed Tomography with Computed Tomography): utilized when MRI, CT myelogram, and CT imaging is inconclusive. A radiotracer is used to identify isolated areas of abnormality.
Each revision surgery is customized, but typical steps include:
- Removal of failed hardware and scar tissue
- New bone grafts, often using advanced biologics or the patient’s own bone to encourage healing
- Stronger stabilization with upgraded instrumentation, such as reinforced rods or plates
The Impact of Failed Fusion and the Role of Revision
For Patients with a Previous Failed Fusion
Living with ongoing pain and dysfunction after spinal fusion can be physically and emotionally exhausting. It’s not uncommon to feel disheartened, especially when you’ve already undergone surgery in hopes of relief. However, revision surgery offers a renewed path forward.
Dr. Smith emphasizes that a thorough evaluation is essential to determine the underlying cause of the failure—whether mechanical, biological, or both. From there, he develops a surgical plan designed specifically to correct the issue and restore function.
How Failed Fusion Affects Patients
The consequences of pseudarthrosis go beyond the spine itself:
- Chronic pain limits work, hobbies, and daily routines
- Loss of function or sensation
- Spinal instability may accelerate degeneration in adjacent segments
- Emotional distress and a decline in mental health are common when pain persists without answers
Recovery and Outcomes
Post-operative Care
Revision surgeries are more complex than initial spinal fusions, and recovery typically reflects that:
- Pain management: Medications and nerve blocks are used to control post-surgical discomfort
- Bracing: A brace is utilized to support healing and proper posture
- Physical therapy: Begins once healing permits, generally around 6 weeks after surgery. This will focus on rebuilding strength and mobility
- Imaging: Each postoperative visit will utilize x-rays to track the healing of your surgery
Recovery Timeline
Healing from a pseudarthrosis revision can take longer than the original fusion, often ranging from 6 to 12 months. However, many patients begin to notice improvement in pain and function within the first few months.
Long-Term Outcomes
With the right surgical strategy and post-op care, most patients experience:
- Significant pain reduction
- Improved function and mobility
- Improved spinal stability
- Renewed ability to return to daily life with confidence
Why Choose Dr. Jeremy Smith
When it comes to revision spine surgery, experience matters. Dr. Jeremy Smith brings years of specialized expertise in complex spinal procedures, including pseudarthrosis revisions. He is known for:
- Developing personalized treatment plans that reflect each patient’s unique anatomy, surgical history, and lifestyle
- Utilizing advanced surgical techniques and technology to optimize outcomes
- Prioritizing patient education and trust, so individuals feel informed and supported every step of the way
Schedule a Consultation
If you're still experiencing pain or neurological symptoms after a spinal fusion, it may be time to seek a second opinion. Dr. Jeremy Smith offers expert evaluation and treatment options for patients dealing with failed fusions, including those performed by other surgeons.
Call today to schedule a consultation at his Orange, CA or Irvine, CA office and take the first step toward restoring your spine—and your life.
