Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery
Open Access
- 23 January 2013
- journal article
- Published by Informa UK Limited in Acta Orthopaedica
- Vol. 84 (1), 7-11
- https://doi.org/10.3109/17453674.2013.771300
Abstract
Background and purpose Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE). Methods All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed the 2-year follow-up were included in the analysis. The outcomes of 3 methods of surgical fusion were assessed. Results Of 1,310 patients enrolled, 115 had undergone uninstrumented fusion, 620 instrumented posterolateral fusion, and 575 instrumented interbody fusion. Irrespective of the surgical procedure, quality of life (QoL) improved and back pain diminished. Change in QoL and functional disability and return to work was similar in the 3 groups. Patients who had undergone uninstrumented fusion had more back pain than the patients with instrumented interbody fusion at the 2-year follow-up (p = 0.02), although the difference was only 7 visual analog scale (VAS) units (95% CI: 1–13) on a 100-point scale. Moreover, 83% of the patients with uninstrumented fusion used analgesics at the end of follow-up as compared to 68% of the patients who had undergone surgery with one of the 2 instrumented fusion techniques. Interpretation In comparison with instrumented interbody fusion, uninstrumented fusion was associated with higher levels of back pain 2 years after surgery. We found no evidence for differences in QoL between uninstrumented fusion and instrumented interbody fusion.Keywords
This publication has 22 references indexed in Scilit:
- Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine?Acta Orthopaedica, 2010
- The Swedish Spine Register: development, design and utilityEuropean Spine Journal, 2009
- Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationalityInternational Orthopaedics, 2008
- The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11–13 year follow-upEuropean Spine Journal, 2007
- Reliability of the prospective data collection protocol of the Swedish Spine Register: Test-retest analysis of 119 patientsActa Orthopaedica, 2006
- One-year report from the Swedish National Spine RegisterActa Orthopaedica, 2005
- Circumferential Lumbar Spinal Fusion With Brantigan Cage Versus Posterolateral Fusion With Titanium Cotrel–Dubousset InstrumentationSpine, 2002
- Compensation, Work Status, and Disability in Low Back Pain PatientsSpine, 1995
- The Effects of Compensation on Recovery from Low-Back InjurySpine, 1989
- Analysis of 2932 Workersʼ Compensation Back Injury CasesSpine, 1987