Long-term outcomes after non-instrumented lumbar arthrodesis.
Non-instrumented lumbar fusion is an accepted technique for the treatment of various spinal degenerative pathologies. The purpose of this study is to report long-term outcomes of patients undergoing in situ fusion. A retrospective review was performed at a single institution over a 20 year period. The main outcome variables were symptom resolution at last follow-up, development of adjacent segment disease (ASD) and overall need for re-operation. A total of 376 patients were identified, with a mean age of 61.1±standard deviation of 13.54 years. The most common presenting symptom was back pain in 344 (91.5%) patients, followed by radiculopathy in 304 (80.9%) patients. The most common pre-operative diagnosis was multi-level spinal stenosis with claudication in 211 (56.1%) patients. At last follow-up, the prevalence of back pain (60.64%; p<0.001) and radiculopathy (57.71%; p<0.001) were significantly lower. The cumulative rate of ASD was 18.35% (69 patients). In total, the rate of re-operation due to non-improvement or worsening of symptoms was 30.59% (115 patients). In this manuscript, we present one of the largest cohorts of patients undergoing in situ fusion for degenerative lumbar spine disease with a median follow-up time of 92 (range 24-154)months. Although the prevalence of both back pain and radiculopathy was significantly reduced at last follow-up, a significant portion of patients still experienced continued symptoms. Notably, while 18.35% of patients developed ASD, 30.6% of patients required re-operation due to recurrent or worsening symptoms during the follow-up period, highlighting the need for additional stabilization techniques.
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
David
D
Santiago-Dieppa
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mohamad
M
Bydon
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Risheng
R
Xu
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Rafael
R
De la Garza-Ramos
Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Roger
R
Henry
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Daniel M
DM
Sciubba
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jean-Paul
JP
Wolinsky
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ali
A
Bydon
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ziya L
ZL
Gokaslan
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: twitham2@jhmi.edu.
Timothy F
TF
Witham
D001416:Back Pain / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011843:Radiculopathy / Q000453:epidemiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000453:epidemiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
Fusion; In situ; Lumbar; Outcomes