title: Outcomes of Instrumented and Noninstrumented Posterolateral Lumbar Fusion.
abstract: The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of posterolateral lumbar fusion for lumbar stenosis cases requiring bilateral facetectomy in conjunction with a laminectomy. The authors evaluated 34 consecutive patients who had undergone a lumbar laminectomy, bilateral partial facetectomy, and posterolateral fusion at a single institution between 1981 and 1996. They included 25 men and 9 women with a mean age of 42 years (range, 27-57 years). Twenty-three cases were instrumented and 11 were noninstrumented. Mean follow-up was 21 years (range, 15-29 years). Outcomes evaluated included reoperation rate, clinical outcomes evaluated by the Oswestry Disability Index (ODI) score, radiographic evaluations of adjacent segmental degeneration (ASD) and lumbar lordosis, and contributing demographic factors to disease progression. At final follow-up, 17 of the 34 patients had undergone reoperation (43% of the instrumented group and 64% of the noninstrumented group). There were no differences in the reoperation rate or ODI improvement between the instrumented and noninstrumented groups (P>.05). Female patients required more revisions, had less ODI improvement, had greater postoperative ASD, and had less maintenance of their postoperative lumbar lordosis. There was no difference in maintenance of postoperative lumbar lordosis or ASD between the instrumented and noninstrumented groups. Instrumentation did not improve revision rates, clinical outcomes, or radiographic outcomes in laminectomies requiring contemporaneous facetectomies.
authors.forename: Sina
authors.initials: S
authors.lastname: Pourtaheri
authors.forename: Charles
authors.initials: C
authors.lastname: Billings
authors.forename: Michael
authors.initials: M
authors.lastname: Bogatch
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.forename: Christopher
authors.initials: C
authors.lastname: Haraszti
authors.forename: Daniel
authors.initials: D
authors.lastname: Mangel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lord
authors.forename: Howard
authors.initials: H
authors.lastname: Park
authors.forename: Remi
authors.initials: R
authors.lastname: Ajiboye
authors.forename: Adedayo
authors.initials: A
authors.lastname: Ashana
authors.forename: Arash
authors.initials: A
authors.lastname: Emami
mesh_terms: D000328:Adult; D000818:Animals; D004867:Equipment Design; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008141:Lordosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013130:Spinal Stenosis / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome