As adult spinal deformity surgery is performed more and more, the spine surgeon is faced with the challenge to treat pseudoarthrosis. The presentation may vary, from asymptomatic patients, who should be observed in most of the cases, to patients with acute episode of broken rods, and or chronic pain with often trunk imbalance. In some instances, patients will present with neurologic symptoms. The evaluation of such patients must start with a good understanding of why the surgery failed first place. Poor host, smoking, lack of anterior column support, poor sagittal balance, lack of fusion, poor construct. Often a combination of all of the above is encountered. The workup for such cases consists of imaging studies (with often a CT myelogram as the excessive metal artifact will render the MRI imaging useless), nutrition labs, DEXA scan, EOS films and internal medicine or cardiology consult for risk stratification as this may represent major surgery. Indication of surgery is mostly based on pain and imbalance and/or poor function. The surgeon planning a revision adult deformity surgery has many tasks to perform: Identify and avoid the reasons that lead to failure of the previous surgeries. Plan the anterior column reconstruction either through posterior or anterior interbody fusion. Restore the global alignment through anterior or posterior osteotomies to achieve sagittal and coronal balance. Obtain a solid fixation with sufficient levels above and below the osteotomies sites with in some cases the use of pelvic screws and four rods (Quad-Rod) techniques. The use of bone graft (either autologous, allograft, bone graft enhancers and inducer) agents. The requirement of decompression either through a virgin spine or a previous laminectomy bed. Despite the extent of these surgeries and the potential for immediate postoperative complications, the outcome is in most cases satisfactory if these goals are achieved. In this review, the authors explore different scenarios for pseudoarthrosis in the adult spine deformity patient and the preferred treatment method to obtain the best outcome for every individual patient. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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成人脊柱畸形不愈合的翻修手术。

随着成人脊柱畸形手术的执行越来越多，脊柱外科医生面临着治疗假性关节炎的挑战。表现可能会有所不同，从无症状患者（在大多数情况下应观察到）到患有急性杆断裂发作或伴有躯干失衡的慢性疼痛的患者。在某些情况下，患者会出现神经系统症状。对此类患者的评估必须从对手术失败首位原因的深刻理解开始。宿主不良，吸烟，前柱支撑不足，矢状平衡差，融合不足，构造不良。通常会遇到以上所有情况的组合。这种情况的检查工作包括影像学检查（通常会进行CT脊髓造影，因为过多的金属伪影会使MRI影像学无用），营养实验室，DEXA扫描，EOS胶片和内科或心脏病学会商定风险分层，因为这可能代表进行大手术。手术指征主要基于疼痛和不平衡和/或功能差。计划翻修成人畸形手术的外科医生有许多任务要执行：确定并避免导致先前手术失败的原因。通过后路或前路椎间融合来计划前柱重建。通过前或后截骨术恢复整体对准，以达到矢状和冠状的平衡。在某些情况下，使用骨盆螺钉和四杆（Quad-Rod）技术获得在截骨部位上方和下方具有足够水平的牢固固定。使用骨移植（自体，同种异体移植，骨移植增强剂和诱导剂）制剂。需要通过原始脊柱或先前的椎板切除床进行减压。尽管这些手术的范围以及术后立即发生并发症的可能性，但如果实现了这些目标，则在大多数情况下结果令人满意。在这篇综述中，作者探讨了成人脊柱畸形患者假性关节炎的不同情况，以及为每个患者获得最佳治疗效果的首选治疗方法。这些幻灯片可以在电子补充材料下找到。作者探讨了成人脊柱畸形患者假性关节炎的不同情况，以及为每位患者获得最佳治疗效果的首选治疗方法。这些幻灯片可以在电子补充材料下找到。作者探讨了成人脊柱畸形患者假性关节炎的不同情况，以及为每位患者获得最佳治疗效果的首选治疗方法。这些幻灯片可以在电子补充材料下找到。