A Prospective Randomized Comparison of 270° Fusions to 360° Fusions (Circumferential Fusions)

Abstract

Prospective randomized comparison of anterior lumbar interbody fusion (ALIF) plus transpedicular instrumentation plus posterolateral fusion (PLF) (360° fusion) to ALIF plus transpedicular instrumentation without PLF (270° fusion). To compare the clinical outcomes, costs, and utilization of health resources of 360°versus 270° fusions. The 360° fusion is effective, but its costs and utilization of health resources are high. The PLF often resorbs and may not be necessary. Before and after surgery pain was measured by the Numerical Rating Scale (NRS), and function was measured by the Oswestry Low Back Disability Index (OSI). Costs were calculated by billing records. Operating times, blood loss, and hospital stays were measured at the time of hospital discharge. There were 48 patients: 21 women and 27 men. Mean age was 42 years. Follow-up averaged 35 months (range 24–45 months). In both 360° and 270° fusions, there were significant improvements in NRS and OSI, and the percentage of solid ALIF was high. Only 14% of PLF appeared solid bilaterally and 18% appeared solid on one side only. There were no significant differences in changes in NRS, changes in OSI, or percentage solid ALIF between the 360° and 270° fusions. However, the 270° fusion group had significantly less blood loss, shorter operative times, shorter hospital stays, and lower professional fees, and although hospital charges were lower, this difference was not significant. Both the 360° and 270° fusions significantly reduce pain and improve function, and there are no significant clinical differences between them. However, there were shorter operating times, less blood loss, lower costs, and less utilization of health care resources associated with the 270° fusions.