Skip to main content

Advertisement

Log in

The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11–13 year follow-up

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Introduction Few studies have investigated the long-term effect of posterolateral lumbar spinal fusion on functional outcome. Aim To investigate the long-term result after posterolateral lumbar spinal fusion with and without pedicle screw instrumentation. Methods Questionnaire survey of 129 patients originally randomised to posterolateral lumbar spinal fusion with or without pedicle screw instrumentation. Follow-up included Dallas Pain Questionnaire (DPQ), Oswestry Disability Index (ODI), SF-36 and a question regarding willingness to undergo the procedure again knowing the result as global outcome parameter. Results Follow-up was 83% of the original study population (107 patients). Average follow-up time was 12 years (range 11–13 years). DPQ-scores were significantly lower than preoperatively in both groups (P < 0.005) and no drift towards the preoperative level was seen. No difference between the two groups were observed (instrumented vs. non-instrumented): DPQ Daily Activity mean 37.0 versus 32.0, ODI mean 33.4 versus 30.6, SF-36 PCS mean 38.8 versus 39.8, SF-36 MCS mean 49.0 versus 53.3. About 71% in both groups were answered positively to the global outcome question. Patients who had retired due to low back pain had poorer outcome than patients retired for other reasons, best outcome was seen in patients still at work (P = 0.01 or less in all questionnaires, except SF-36 MCS P = 0.08). Discussion Improvement in functional outcome is preserved for 10 or more years after posterolateral lumbar spinal fusion. No difference between instrumented fusion and non-instrumented fusion was observed. Patients who have to retired due to low back pain have the smallest improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Reference

  1. Bjorner JB, Kreiner S, Ware JE, Damsgaard MT, Bech P (1998) Differential item functioning in the Danish translation of the SF-36. J Clin Epidemiol 51:1189–1202

    Article  PubMed  CAS  Google Scholar 

  2. Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P (1998) The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 51:991–999

    Article  PubMed  CAS  Google Scholar 

  3. Bono CM, Lee CK (2005) The influence of subdiagnosis on radiographic and clinical outcomes after lumbar fusion for degenerative disc disorders: an analysis of the literature from two decades. Spine 30:227–234

    Article  PubMed  Google Scholar 

  4. Brox J.I, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28:1913–1921

    Article  PubMed  Google Scholar 

  5. Brox JI, Reikeras O, Nygaard O, Sorensen R, Indahl A, Holm I, Keller A, Ingebrigtsen T, Grundnes O, Lange JE, Friis A (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145–155

    Article  PubMed  Google Scholar 

  6. Buttermann GR, Garvey TA, Hunt AF, Transfeldt EE, Bradford DS, Boachie-Adjei O, Ogilvie JW (1998) Lumbar fusion results related to diagnosis. Spine 23:116–127

    Article  PubMed  CAS  Google Scholar 

  7. Cheung EV, Herman MJ, Cavalier R, Pizzutillo PD (2006) Spondylolysis and spondylolisthesis in children and adolescents: II. surgical management. J Am Acad Orthop Surg 14:488–498

    PubMed  Google Scholar 

  8. Christensen FB, Hansen ES, Laursen M, Thomsen K, Bunger CE (2002) Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine 27:1269–1277

    Article  Google Scholar 

  9. Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery—the case for restraint. N Engl J Med 350:722–726

    Article  PubMed  CAS  Google Scholar 

  10. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI (2005) United States trends in lumbar fusion surgery for degenerative conditions. Spine 30:1441–1445

    Article  PubMed  Google Scholar 

  11. Ekman P, Moller H, Hedlund R (2005) The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J 5:36–44

    Article  PubMed  Google Scholar 

  12. Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine 25:2940–2953

    Article  PubMed  CAS  Google Scholar 

  13. Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233

    Article  PubMed  Google Scholar 

  14. Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) 2001 volvo award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group. Spine 26:2521–2532

    Article  PubMed  CAS  Google Scholar 

  15. Fritzell P, Hagg O, Wessberg P, Nordwall A (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27:1131–1141

    Article  PubMed  Google Scholar 

  16. Fritzell P, Hagg O, Nordwall (2006) A 5–10 years follow up in the Swedish lumbar spine study. Abstract A124, Spineweek 2004, Porto

  17. Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated cochrane review. Spine 30:2312–2320

    Article  PubMed  Google Scholar 

  18. Glaser J, Stanley M, Sayre H, Woody J, Found E, Spratt K (2003) A 10-year follow-up evaluation of lumbar spine fusion with pedicle screw fixation. Spine 28:1390–1395

    Article  PubMed  Google Scholar 

  19. Glassman S, Gornet MF, Branch C, Polly D Jr, Peloza J, Schwender JD, Carreon L (2006) MOS short form 36 and oswestry disability index outcomes in lumbar fusion: a multicenter experience. Spine J 6:21–26

    Article  PubMed  Google Scholar 

  20. Jacobs WC, Vreeling A, De KM (2006) Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J 15:391–402

    Article  PubMed  Google Scholar 

  21. Lamberg TS, Remes VM, Helenius IJ, Schlenzka DK, Yrjonen TA, Osterman KE, Tervahartiala PO, Seitsalo SK, Poussa MS (2005) Long-term clinical, functional and radiological outcome 21 years after posterior or posterolateral fusion in childhood and adolescence isthmic spondylolisthesis. Eur Spine J 14:639–644

    Article  PubMed  Google Scholar 

  22. Lawlis GF, Cuencas R, Selby D, McCoy CE (1989) The development of the Dallas Pain Questionnaire. An assessment of the impact of spinal pain on behavior. Spine 14:511–516

    Article  PubMed  CAS  Google Scholar 

  23. Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A (1994) Low back pain rating scale: validation of a tool for assessment of low back pain. Pain 57:317–326

    Article  PubMed  CAS  Google Scholar 

  24. Moller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis: A prospective randomized study: part 1. Spine 25:1711–1715

    Article  PubMed  CAS  Google Scholar 

  25. Mulholland RC (2001) Comment on topographic relations of neural and ligamentous structures of the lumbosacral junction: in vitro investigation. Spondylolisthesis-no reduction, partial reduction or total reduction? Eur Spine J 10:133–134

    Article  PubMed  CAS  Google Scholar 

  26. Poussa M, Remes V, Lamberg T, Tervahartiala P, Schlenzka D, Yrjonen T, Osterman K, Seitsalo S, Helenius I (2006) Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 31:583–590

    Article  PubMed  Google Scholar 

  27. Soegaard R, Christensen FB, Christiansen T, Bunger C (2007) Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J 16:657–668

    Article  PubMed  Google Scholar 

  28. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE (1997) 1997 volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine 22:2813–2822

    Article  PubMed  CAS  Google Scholar 

  29. Videbaek TS, Christensen FB, Soegaard R, Hansen ES, Hoy K, Helmig P, Niedermann B, Eiskjoer SP, Bunger CE (2006) Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine 31:2875–2880

    Article  PubMed  Google Scholar 

  30. Ware JE Jr (2000) SF-36 health survey update. Spine 25:3130–3139

    Article  PubMed  Google Scholar 

  31. Zanoli G, Jonsson B, Stromqvist B (2006) SF-36 scores in degenerative lumbar spine disorders. Analysis of prospective data from 451 patients. Acta Orthop 77:298–306

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Andersen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andersen, T., Videbæk, T.S., Hansen, E.S. et al. The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11–13 year follow-up. Eur Spine J 17, 272–280 (2008). https://doi.org/10.1007/s00586-007-0494-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-007-0494-8

Keywords

Navigation