Manuel Fernandes Marques, Vincent Fiere, Ibrahim Obeid, Yann-Philippe Charles, Khaled El-Youssef, Abi Lahoud, Joe Faddoul, Emmanuelle Ferrero, Guillaume Riouallon, Clément Silvestre, Jean-Charles Le Huec, David Kieser, Louis Boissiere

November 2021, Volume 30, Issue 11, pp 3225 - 3232 Original Article Read Full Article 10.1007/s00586-021-06861-w

First Online: 05 May 2021

Pseudarthrosis in adult spine deformity surgery: risk factors and treatment options


Highlight risk factors for pseudarthrosis in long-segment spinal fusions, collect the approaches carried to address this complication.


Patients with ASD and fusion of ≥ 4 levels with minimum follow-up (FU) of ≥ 2 years were included. Full-body X-rays were done preoperatively, 


Out of 524 patients included, 65 patients (12.4%) developed pseudarthrosis and 53 underwent revision surgery. Notably, 88% of pseudarthrosis cases are associated with fusion length (OR = 1.17, 95% CI = 1.05–1.292, p = 0.004), osteotomy requirement (OR = 0.28, 95% CI = 0.09–0.85, p = 0.025), pelvic fixation (OR = 0.34, 95% CI = 0.13–0.88, p = 0.026) and combined approaches (OR = 3.29, 95% CI = 1.09–9.91, p = 0.034). Sagittal alignment is not related to the rate of pseudarthrosis. Health related and quality of life scores were comparable at last FU between patients revised for pseudarthrosis and those that didn’t require revision surgery (ODI = 28% no revision and 30% revision group).


Pseudarthrosis is not related to malalignment, but with the surgical techniques employed for its treatment. Anterior approaches with anterior support decrease the rate by 30%, while long fusions, osteotomies and pelvic fixation increase its rate.

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