title: Impact of Surgical Approach on Clinical Outcomes in the Treatment of Lumbar Pseudarthrosis.
abstract: Study DesignRetrospective comparative cohort.ObjectivePseudarthrosis following fusion for degenerative lumbar spine pathologies remains a substantial problem. Current data shows that patients who develop a pseudarthrosis have suboptimal outcomes. This study evaluates if treatment of pseudarthrosis can be affected by surgical approach.MethodsMedical records of 63 female and 65 male patients (mean age 50.37) who were treated for nonunion following lumbar fusion were reviewed. Sixty patients underwent posterolateral fusion (PSF), 18 underwent PSF with transforaminal interbody fusion (TLIF), 32 underwent anterior and posterior spinal fusion (AP), and 24 underwent anterior lumbar interbody fusion (ALIF).ResultsSignificant differences between the treatment groups were observed in length of stay (p= 0.000), blood loss (p= 0.000), and operative time (p= 0.000). In the AP fusion group, minimal clinically important difference (MCID) was reached in 47% of patients for back pain, 28% for leg pain, and 28% for Oswestry Disability Index (ODI). PSF had the highest percentage of patients reaching MCID for Short Form-36 (SF-36) physical composite score at 25%. ALIF and TLIF subgroups reached MCID for ODI in 17% of patients. Linear regression analysis showed that type of surgical approach did not impact change in ODI scores.ConclusionAlthough not statistically significant, the AP fusion group reached MCID more frequently in all outcomes except SF-36 Physical Component Summary. All surgical approaches examined for treatment of lumbar pseudarthrosis resulted in only poor to modest improvement in ODI. This result further emphasizes the importance of achieving a solid fusion with the index surgery.
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: R Kirk
authors.initials: RK
authors.lastname: Owens
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: Mladen
authors.initials: M
authors.lastname: Djurasovic
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: Dimar
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky, United States.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
keywords: lumbar fusion; nonunion; outcomes; revision spine surgery; surgical approach