title: Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain.
abstract: BACKGROUND
  Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD.
  
  
  METHODS
  Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS).
  
  
  RESULTS
  The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.
  
  
  CONCLUSIONS
  Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.
authors.affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.
authors.forename: Ara J
authors.initials: AJ
authors.lastname: Deukmedjian
authors.affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.
authors.forename: Augusto J
authors.initials: AJ
authors.lastname: Cianciabella
authors.affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Cutright
authors.affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.
authors.forename: Arias
authors.initials: A
authors.lastname: Deukmedjian
keywords: Back pain; degenerative disc disease; discogenic pain; spinal fusion; spinal fusion outcomes