title: Does fusion status after posterior lumbar interbody fusion affect patient-based QOL outcomes? An evaluation performed using a patient-based outcome measure.
abstract: BACKGROUND
  Although delayed union or pseudoarthrosis after lumbar arthrodesis has been recognized as a major radiographic complication, little has been known about the effect of fusion status on the patient's quality-of-life (QOL) outcome. The purpose of this study was to investigate the effects of fusion status after posterior lumbar interbody fusion (PLIF) on QOL outcomes by using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).
  
  
  METHODS
  Among 100 patients who underwent single level PLIF for spinal canal stenosis, 29 who had not achieved fusion (incomplete fusion group) and 29 age- and sex ratio-matched patients who had achieved fusion (fusion group) 6 months after surgery were enrolled. Overall clinical evaluation was performed before and 6 months after surgery: the physician determined the Japanese Orthopaedic Association Score for Low Back Pain (JOA score); the JOABPEQ and visual analogue scale (VAS) values were collected. The recovery rate of the JOA score, changes in all JOABPEQ subdomain scores and in the VAS values were calculated. All variables were compared between the groups.
  
  
  RESULTS
  The preoperative JOA scores, JOABPEQ scores of all subdomains, and VAS values of all categories did not differ between the groups. The recovery rate was higher in the fusion group than the incomplete fusion group (p = 0.0185). The changes in the JOABPEQ scores for walking ability and social life function were significantly greater in the fusion group than the incomplete fusion group (walking ability, p = 0.0172; social life function, p = 0.0191). The postoperative VAS values and changes in the VAS values for all categories did not differ between the groups.
  
  
  CONCLUSIONS
  Incomplete fusion after PLIF correlated with poor improvement in walking ability and social life function. Therefore, the achievement of fusion after PLIF is essential to obtain better patient QOL outcomes.
authors.affiliation: Department of Orthopedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan, t-makino@za2.so-net.ne.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Makino
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaito
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ishii
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yonenobu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012919:Social Behavior; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D016138:Walking