Update on the Diagnosis and Treatment of Lumbar Nonunions

Strategies in the diagnosis and treatment of lumbar nonunion were reviewed. The reported rates of lumbar nonunion ranged from 5 to 70% of cases depending on surgical technique. Risk factors include tobacco use, malnutrition, oral anti-inflammatory use, multilevel fusion, prior spine surgery, and sagittal imbalance. Diagnosis can be based on history, examination, and radiographic imaging including reconstructed computed tomography. The surgical approach is guided by prior surgery as well as the sagittal balance of the spine. The use of autologous bone graft as well as biologic graft extenders or substitutes may be of benefit. Lumbar nonunion presents a difficult clinical scenario. Surgical revision yields high fusion rates but may not improve functional outcomes.