Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery. A study of 1,310 patients with degenerative disc disease from the Swedish Spine Register SWESPINE.
OBJECTIVE
Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE).


METHODS
All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed the 2-year follow-up were included in the analysis. The outcomes of 3 methods of surgical fusion were assessed.


RESULTS
Of 1,310 patients enrolled, 115 had undergone uninstrumented fusion, 620 instrumented posterolateral fusion, and 575 instrumented interbody fusion. Irrespective of the surgical procedure, quality of life (QoL) improved and back pain diminished. Change in QoL and functional disability and return to work was similar in the 3 groups. Patients who had undergone uninstrumented fusion had more back pain than the patients with instrumented interbody fusion at the 2-year follow-up (p = 0.02), although the difference was only 7 visual analog scale (VAS) units (95% CI: 1-13) on a 100-point scale. Moreover, 83% of the patients with uninstrumented fusion used analgesics at the end of follow-up as compared to 68% of the patients who had undergone surgery with one of the 2 instrumented fusion techniques.


CONCLUSIONS
In comparison with instrumented interbody fusion, uninstrumented fusion was associated with higher levels of back pain 2 years after surgery. We found no evidence for differences in QoL between uninstrumented fusion and instrumented interbody fusion.
Department of Orthopaedics, Institute for Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden. yohan.robinson@surgsci.uu.se
Yohan
Y
Robinson
Karl
K
Michaëlsson
Bengt
B
Sandén
D000203:Activities of Daily Living; D001416:Back Pain / Q000601:surgery*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome