[Surgical treatment of degenerative lumbar diseases].
BACKGROUND
The diagnosis and treatment of painful degenerative spinal diseases remains controversial in the literature, and surgical treatment differs greatly between centres and surgeons. We have evaluated our results over a nine-year period.


METHODS
237 patients referred with chronic degenerative spinal diseases could be evaluated, 132 women and 105 men, median age 48 (17 - 85). Median symptom duration was 10 years (1.5 - 50 years). The patient files were retrospectively studied independently by two surgeons. Out of the patients, 83 (35 %) had previously had lumbar spine operations, mainly discectomies. All patients were controlled as outpatients with clinical examination and an X-ray taken of the lower spine columna at least once. The final evaluation of patient satisfaction with the operation, pain and walking and working capacity was based on a questionnaire.


RESULTS
Out of these patients, 64 were treated with decompression only, 173 had additional posterolateral fusion with bone or instrument. Fusion rate was 90 %, with no significant difference between type of fusion (p = 0.07). After a median observation time of 5.2 years (0.5 - 10.5 years) 75 % of the patients were very satisfied or satisfied with the outcome; 48 % were back at work. Factors significantly related to poor results were little preoperative pain (p < 0.001), previous back operations (p = 0.003) and long preoperative sick leave (p = 0.015).


CONCLUSIONS
Our results are comparable with most published studies. One should be restrictive with surgery on patients with little pain, long sick leave, preoperative inactivity, and previous multiple spinal operations.
Bjerkeset
Tormod
T
Kirurgisk avdeling, Sykehuset Levanger, 7600 Levanger. tormod.bjerkeset@c2i.net
Johnsen
Lars Gunnar
LG
Kibsgaard
Leif
L
Fuglesang
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D019299:Decompression, Surgical; D017586:Diskectomy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion