The 'Lumbar Fusion Outcome Score' (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain.
In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes - as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) - were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up. In conclusion,  LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.
Department of Neurosurgery, Brain and Spine Center - Invision Health, 400 International Drive, Buffalo, NY, 14221, USA. tobiasmattei@yahoo.com.
Tobias A
TA
Mattei
Department of Neurosurgery, West Virginia University, Morgantown, WV, USA.
Azeem A
AA
Rehman
Department of Neurosurgery, Montreal Neurological Hospital and Institute / McGill University, Montreal, Canada.
Alisson R
AR
Teles
Department of Neurosurgery, West Virginia University, Morgantown, WV, USA.
Jean C
JC
Aldag
Department of Neurological Surgery, College of Medicine, The University of Illinois, Peoria, IL, USA.
Dzung H
DH
Dinh
Department of Neurological Surgery, College of Medicine, The University of Illinois, Peoria, IL, USA.
Todd D
TD
McCall
D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
Anterior lumbar interbody fusion; Bone scan; Chronic low back pain; Degenerative disc disease; Lumbar spinal fusion; Modic endplate changes