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Home > Non-union of Spinal Bones in Fusion Surgery: Part II – Treatment

Non-union of Spinal Bones in Fusion Surgery: Part II – Treatment

Jeffrey R. Carlson, MD, CPE, FAAOSJeffrey R. Carlson, MD, MBA, CPE, FAOOS

 Treatment of Non-union

The management of non-union in spinal fusion surgery involves a multimodal approach tailored to individual patient characteristics. The following treatment options can be considered:

  1. Revision surgery:                                                                       In cases where non-union is identified early and the underlying cause can be addressed surgically, revision surgery may be necessary. This involves removing any hardware or instrumentation, debriding the non-union site, and promoting a healthy environment for bone healing. Bone grafts or bone-stimulating agents may be utilized to enhance fusion.
    • Extension of fusion: Expanding the fusion to include additional levels to enhance stability and promote fusion.
    • Hardware revision: Replacing or reinforcing existing hardware to improve fixation and stability.
    • Bone grafting: Harvesting bone graft material, either autograft (from the patient’s own body) or allograft (from a donor) and placing it at the non-union site to stimulate bone healing.
  2. Bone stimulation:
    • Electrical bone stimulation and ultrasound therapy are non-invasive treatment modalities that can promote bone healing. These methods provide low-intensity electrical or ultrasound energy to the fusion site, stimulating the production of bone-forming cells and accelerating the fusion process.
    • Biological stimulation:
      1. Bone morphogenetic proteins (BMPs): Application of genetically engineered proteins that promote bone formation and fusion.
  3. Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to reduce inflammation and pain associated with non-union. However, caution should be exercised when using NSAIDs, as they may interfere with bone healing in some cases.
  4. Interventional Pain Management: Interventional Procedures, Injections and Medications to address persistent pain associated with non-union.
  5. Physical Therapy: Incorporating exercises and rehabilitation to improve spinal stability and strengthen supporting musculature.
  6. Adjunctive/Lifestyle modifications: Acupuncture, massage therapy, aqua therapy, aromatherapy, meditation, Mindfulness, CBT, Psychotherapy. Patients are advised to quit smoking and avoid nicotine-containing products, as nicotine can negatively impact bone healing. Additionally, optimizing nutrition and overall health through a balanced diet, regular exercise, and weight management can support bone healing.

Non-union in spinal fusion surgery poses a significant challenge for both patients and surgeons. Obviously, prevention is key. I try to prevent non-union by being careful with patient selection for spinal fusions and surgical planning, where I assess patient risk factors and their overall health before surgery. Intraoperatively, proper surgical techniques, adequate stabilization, and meticulous hemostasis should be prioritized. Postoperative care, including getting the patient to give up smoking, weight management, and physical therapy, can also contribute to successful fusion and reduce the risk of non-union.

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