ABSTRACT
With the expanding knowledge of the lumbar spine and our increasing diagnostic skills and technology, greater pathology of the spine is being identified. These tools have lead the spine surgeon to identify pathologic processes that can be treated surgically. With this ability and the increase in spinal surgery and fusion surgeries being performed, surgeons are still frustrated with the high incidence of potential nonunions. In situ fusion has had good success but was not perfect with its incidence of nonunion (1-3). With the advent of instrumentation and the technologies that go along with this, the incidence of pseudoarthrosis has decreased but it is still a known risk (4-11). Also, greater awareness of underlying metabolic conditions and risk factors has also enhanced our understanding of fusion technology and what contributes to a nonunion. But we still see pseudoarthrosis in spinal fusion surgeries and question whether we can further decrease this incidence (5,7,3,12).
