Long-Term Lumbar Fusion Outcomes

INTRODUCTION
Although the effectiveness of lumbar fusion procedures for patients with severe low back pain and degenerative conditions is established for short term period followup, the long term followup has had less study.  Within the primary care community, there is skepticism regarding the long term results of lumbar spinal fusion in certain regards.  In the past, lumbar fusion outcomes have had suboptimal results in patients who develop pseudoarthroses.  However, with current techniques the pseudarthrosis rate has decreased substantially.  Thus, outcomes using modern fusion techniques should be improved. The purpose of this study was to assess the long term outcomes of lumbar spinal fusion patients using modern techniques and methods. 
Lumbar spinal fusion patients were enrolled during the four-year period of January 2003 through February 2007. Patients included had a posterior spinal fusion with or without decompression, anterior/posterior spinal fusion technique with or without decompression, as well as patients having a TLIF or PLIF procedure.  The total number of patients was over 450.  The outcomes were assessed by a blinded reviewer.  The specific outcomes measurement scales included pain scale for the low back and legs, a functional assessment using the Oswestry Disability Index, and pain distribution assessed by a Pain Diagram.  Also assessed were narcotic intake before and after surgery and throughout the followup period, as well as patientsí self perception of treatment success, if the patient would refer another patient for this type of procedure, and whether the patient would have the procedure done again under similar situations.
RESULTS
Patient outcomes completion response rate ranged for 100% at the 7-12 month followup period to approximately 86% at the greater than five-year followup period.  For all groups there was significant improvement in back pain, leg pain, as well as function.  The degree of outcomes improvement was similar for all groups.  However, it should be noted there was substantial variability in all groups which is typical for this patient population.  Interestingly, the TLIF group which had the least number of levels treated on average had the highest implant cost and hospitalization charges.  Finally, the results to date suggest a slight increase in pain in patients who were over five years from their lumbar fusion surgery date.  However, the numbers are still incomplete and thus this may not be significant.
DISCUSSION
Lumbar spinal fusion achieves improvement in pain and functional outcomes in the short term and intermediate term.  Long term results are still pending.  The actual type of procedure to achieve the lumbar fusion does not seem to be a significant factor in achieving good outcomes.  Patients should proceed with a lumbar fusion that their surgeon is most comfortable with.

 

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