title: Management of chronic disabling low back pain with 360 degrees fusion. Results from pain provocation test and concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation in patients with chronic disabling low back pain.
abstract: METHODS
  A follow-up study conducted by an independent observer was performed on the authors' first 29 consecutive patients treated with concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation, for whom at least 2 years had transpired since the operation.
  
  
  OBJECTIVE
  To evaluate the results of concurrent instrumented posterior lumbar interbody fusion and posterolateral fusion used to manage chronic disabling low back pain.
  
  
  BACKGROUND
  Patients chosen for surgery all had a history of chronic disabling low back pain exceeding 2 years and a sick leave period in excess of 6 months (average, 3.4 years).
  
  
  METHODS
  From 1989 to 1993, 29 consecutive patients were surgically treated with fusion. The level of fusion was chosen depending on radiologic changes and results from a intradiscal injection provocation test. Bone union was verified by computed tomography scan with 1-mm-thin slices and sagittal reformation, and by a "second look" in all but three patients. All patients were evaluated subsequently by an independent observer in November 1995, 4.7 years after surgery on the average.
  
  
  RESULTS
  Bone fusion was obtained in 27 of the 29 patients (93%). There was a highly significant reduction in back and leg pain measurements. Of the 29 patients, the results were excellent in 9 patients (31%), good in 6 patients (21%), fair in 6 patients (21%), and poor in 8 patients (27%). A total of 18 patients (62%) had returned to work.
  
  
  CONCLUSIONS
  The authors consider posterior lumbar interbody fusion with concurrent posterolateral fusion and pedicle screw instrumentation a possible method for managing chronic disabling low back pain.
authors.affiliation: Department of Orthopaedics, Maelarsjukhuset Eskilstuna, Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Leufvén
authors.forename: A
authors.initials: A
authors.lastname: Nordwall
mesh_terms: D000328:Adult; D001863:Bone Screws; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007866:Leg / Q000503:physiopathology; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D018582:Sick Leave; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome