Is high level of disability an indication for spinal fusion? Analysis of long-term outcome after posterior lumbar interbody fusion using carbon fiber cages.
OBJECTIVE
Posterior lumbar interbody fusion is a recognized procedure for the treatment of back pain associated with degenerative disc disease and segmental instability. It allows decompression of the spinal canal and circumferential fusion through a single posterior incision.


METHODS
Sixty-five consecutive patients who underwent posterior lumbar interbody fusion using carbon cages and pedicle fixation between 1993 and 2000 were recruited and contacted with a postal survey. Clinical outcome was assessed by the postoperative clinical findings and complications and the fusion rate, which was assessed using the scoring system described by Brantigan and Steffee. Functional outcome was measured by using improvement in the Oswestry Disability Index, return to work, and satisfaction with the surgical outcome. The determinants of functional relief were analyzed against the improvement in disability using multiple regression analysis.


RESULTS
The mean postoperative duration at the time of the study was 4.4 years. Overall radiologic fusion rate was 98%. There was a significant improvement in Oswestry Disability Index (P < 0.01). There was 84% satisfaction with the surgical procedure and 61% return to predisease activity level and full employment. We found preoperative level of disability to be the best determinant of functional recovery irrespective of age or the degree of psychological morbidity and litigation (P < 0.01).


CONCLUSIONS
The combination of posterior lumbar interbody fusion and posterior instrumented fusion is a safe and effective method of achieving circumferential segmental fusion. A direct relationship between preoperative level of disability and functional recovery suggests that disability should be measured preoperatively and spinal fusion should be performed to alleviate disability caused by degenerative spine.
Mofidi
Ali
A
From the Elective Spinal Unit, Adelaide and Meath Hospital Incorporating the National Children's Hospital at Tallaght, Dublin, Republic of Ireland. alimofidi@hotmail.com
Sedhom
Majed
M
O'Shea
Kieran
K
Fogarty
Esmonde E
EE
Dowling
Frank
F
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000453:epidemiology* / Q000517:prevention & control*; D001860:Bone Plates / Q000706:statistics & numerical data; D002244:Carbon; D000077482:Carbon Fiber; D015897:Comorbidity; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology* / Q000601:surgery*; D007494:Ireland / Q000453:epidemiology; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D020127:Recovery of Function; D013123:Spinal Fusion / Q000295:instrumentation* / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000077482:Carbon Fiber; D002244:Carbon