Abstract
Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979–1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64 patients a suplemental facet joint fusion was performed. Clinical outcome was evaluated 5–13 years after surgery using the patient-administered Dallas Pain Questionnaire (DPQ). Radiological outcome was determined on the basis of radiographs taken at a 2-year follow-up assessed by independent observers. The radiological follow-up rate was 98%. Complete fusion was found in 52%, questionable fusion in 24%, and definitive pseudoarthrosis in 24% of patients. Radiological results were poor in patients who had undergone previous spinal surgery (P<0.05) and in those with two-level fusion (P<0.05). The DPQ reply rate was 80%. Sixty-six patients claimed improvement in all functional groups. Patients with complete or questionable union had significantly better results than did those with non-union (P<0.01). Poorer functional outcome was found in patients who had undergone previous spinal surgery (P<0.01) or fusion at the L4/L5 level (P<0.05), in those who had responded poorly to the preoperative test brace (P<0.05), and in those above 45 years old at the time of surgery (P<0.05). Radiological and functional outcome did not vary according to whether patients were treated postoperatively with a plaster jacket or with facet screw fixation. The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.
Similar content being viewed by others
References
Akkerveeken PF (1993) Anterior lumbar interbody fusion. Acta Orthop Scand [Suppl] 251:105–107
Christensen FB, Bünger C (1995) Retrograde ejaculation — an ignored complication in anterior lumbo-sacral fusion (abstract). Nordic Scoliosis Society Conference, Helsinki 16–18 June
Christensen FB, Thomsen K, Brødsgard I, et al (1993) Functional outcome after lumbar posterolateral spondylodesis with and without pedicle screw fixation (abstract). Nordic Scoliosis Society Conference, Oslo 11–13 June
Fairbank JC, Couper J, Davies JB, et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Greenough C, Fraser R (1992) Assessment of outcome in patients with low-back pain. Spine 17:36–41
Greenough C, Fraser R (1994) Aetiology, diagnosis and treatment of low back pain. Eur Spine J 3:22–27
Greenough C, Taylor L, Fraser R (1994) Anterior lumbar fusion: results, assessment techniques and prognostic factors. Eur Spine J 3:225–230
Holte DC, O'Brien JP, Renton P (1994) Anterior lumbar fusion using a hybrid interbody graft. Eur Spine J 3: 32–38
Kim SS, Denis F, Lonstein JE, Winter RB (1990) Factors affecting fusion rate in adult spondylolisthesis. Spine 15:979–984
LaRocca H (1990) Failed lumbar surgery. In: Weinstein J, Wiesel S (eds) The lumbar spine. Saunders, Philadelphia, pp 872–881
Lawlis GF, Cuencas R, Selby D, et al (1989) The development of the Dallas Pain Questionnaire. An assessment of the impact of spinal pain on behavior. Spine 14:511–516
Main CJ, Waddell G (1987) Psychometric construction and validity of the Pilowsky Illness Behaviour Questionnaire in British patients with chronic low back pain. Pain 28:13–25
Mardjetko S, Connolly P, Shott S (1994) Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993. Spine 19:2256–2262
Meyerding HW (1932) Spondylolisthesis. Surg Gynecol Obstet 54:371–377
Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299
Roye DP, Farcy JP (1987) Lumbosacral fusion. In Camins M, O'Leary P (eds) The lumbar spine. Raven Press, New York, pp 309–340
Slosar PJ, Reynolds JB, Schofferman J et al (1994) Combined anterior and posterolateral lumbar fusions: primary and revision. Proceedings of the North Americas Spine Society, October 19–24, Minneapolis, pp 23–24
Spengler DM, Ouellette EA, Battie M, et al (1990) Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method. J Bone Joint Surg [Am] 72:230–237
Steffee AD, Brantigan JW (1993) The variable screw placement spinal fixation system. Report of a prospective study of 250 patients enrolled in Food and Drug Administration clinical trials. Spine 18:1160–1172
Sørensen K (1978) Anterior interbody lumbar spine fusion for incapacitating disc degeneration and spondylolisthesis. Acta Orthop Scand 49:269–277
Thomas A (1983) Ejaculatory dysfunction. Fertil Steril 39:445–453
Thomasen E (1985) Intercorporal lumbar spondylodesis. 312 patients followed for 2–20 years. Acta Orthop Scand 56:287–293
Turner JA, Herron L, Deyo RA (1993) Meta-analysis of the results of lumbar spine fusion. Acta Orthop Scand [Suppl] 251:120–122
Waddell G (1987) Clinical assessment of lumbar impairment. Clin Orthop 221:110–120
Waddell G, Kummel EG, Lotto WN, et al (1979) Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg [Am] 61: 201–207
Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18:983–991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Christensen, F.B., Karlsmose, B., Hansen, E.S. et al. Radiological and functional outcome after anterior lumbar interbody spinal fusion. Eur Spine J 5, 293–298 (1996). https://doi.org/10.1007/BF00304343
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00304343