title: Fusion rates and SF-36 outcomes after multilevel laminectomy and noninstrumented lumbar fusions in a predominantly geriatric population.
abstract: METHODS
  This study prospectively analyzed posterolateral fusion rates and Short-Form 36 (SF-36) outcomes after multilevel lumbar laminectomies and noninstrumented fusions.
  
  
  OBJECTIVE
  SF-36 outcomes and posterolateral fusion rates were assessed.
  
  
  BACKGROUND
  Technologically advanced and expensive instrumentation techniques and fusion adjuncts (ie, bone morphogenetic protein) may not be necessary to achieve lumbar fusion in the geriatric population. Rather, noninstrumented fusions using lamina autograft and a bone volume expander may suffice.
  
  
  METHODS
  Seventy-five patients averaging 69 years of age (49 females, 26 males) underwent average 4.9 level lumbar laminectomies with average 2.0 level noninstrumented posterolateral fusions using lamina autograft (average 30 cm) supplemented with demineralized bone matrix (average 30 cm) in a 50:50 mix. Two independent radiologists separately evaluated both 2-dimensional computed tomography (2D-CT) and dynamic x-ray data 3, 4.5, 6, and up to 12 months postoperatively; patients had to demonstrate fusion on both studies. Outcomes were assessed using the SF-36 questionnaire (preoperatively) 3, 6, 12, and 24 months postoperatively. Patients were followed an average of 3.3 years (minimum 2 y).
  
  
  RESULTS
  Thirteen (17.3%) patients demonstrated pseudarthrosis as they had not fused on dynamic x-ray and/or 2D-CT studies an average of 5.6 months postoperatively. One patient required a secondary fusion. One and 2 years postoperatively, patients demonstrated nearly identical maximal improvement on 6 SF-36 Health Scales, but showed no real changes on General Health and Mental Health scales.
  
  
  CONCLUSIONS
  Seventy-five predominantly geriatric patients underwent multilevel laminectomies with noninstrumented fusions using lamina autograft combined with a bone volume expander. Thirteen patients (17.3%) demonstrated pseudarthrosis on the basis of both dynamic x-ray and 2D-CT criteria; 1 patient required a second instrumented fusion. Moderate pseudarthrosis rates, a low reoperation rate, and satisfactory SF-36 outcomes were achieved using noninstrumented posterolateral fusions in a predominantly geriatric population.
authors.affiliation: The Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001857:Bone Matrix / Q000637:transplantation*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome