title: SF-36 outcomes and fusion rates after multilevel laminectomies and 1 and 2-level instrumented posterolateral fusions using lamina autograft and demineralized bone matrix.
abstract: Short-Form 36 (SF-36) outcomes and fusion rates were assessed after multilevel laminectomies and 1 (95 patients) or 2-level (45 patients) instrumented fusions. The posterolateral fusion mass consisted of lamina autograft and demineralized bone matrix (Osteofil/ICM: Sofamor Danek, Memphis, TN) in a 50:50 mix. SF-36 questionnaires were administered preoperatively and 3, 6, and 12 months postoperatively. Two independent neuroradiologists (blinded to study design) separately documented fusion on both dynamic x-rays and two-dimensional-computed tomography (2D-CT) studies performed 3, 6, and up to 12 months postoperatively until arthrodesis was demonstrated. Patients were followed an average of 3 years in both fusion series (minimum of 1.5 y). One-year postoperatively, comparably improved outcomes were observed for both groups on 6 of 8 Health Scales of the SF-36. 2D-CT studies documented 1-level fusion an average of 5.2 months (Standard Deviation 1.8) postoperatively in 88 (92.6%) of 95 cases, whereas dynamic x-rays confirmed fusion in 93 (98%) patients. For 2 patients undergoing 1-level fusions, both 2D-CT and dynamic x-ray documented pseudarthrosis/instability; both patients required secondary surgery an average of 8 months postoperatively. 2D-CT documented 2-level fusion an average of 6.1 months (Standard Deviation 1.9) postoperatively in 41 of 45 (91.2%) patients, whereas dynamic x-rays confirmed fusion in 43 (96%) patients. For 2 patients undergoing 2-level fusions, both 2D-CT and dynamic x-rays documented pseudarthrosis/instability; both patients required secondary fusion an average of 10 months postoperatively. High fusion rates and adequate outcomes were observed after multilevel laminectomies and 1 and 2-level instrumented posterolateral fusions performed using lamina autograft and demineralized bone matrix: Osteofil/ICM.
authors.affiliation: The Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Epstein
mesh_terms: D001416:Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D001857:Bone Matrix / Q000637:transplantation*; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D011788:Quality of Life; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome