Skip to main content


Log in

Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis

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


It has been reported that in patients undergoing posterolateral lumbar fusion (PLF), the fusion status is not related to the short-term operative results. To determine whether the fusion status influences the long-term operative results of PLF, we retrospectively examined the surgical outcomes of uninstrumented PLF for a minimum of 8 years (average, 9.5 years), by comparing cases exhibiting union with those exhibiting nonunion. Uninstrumented PLF was performed for the treatment of lumbar canal stenosis (LCS) with degenerative spondylolisthesis. Since nine patients were lost to final follow-up, the study included 42 patients, and the follow-up rate was 82.4%. The mean age of the patients was 64.1 years (range 46–77 years). Eight patients exhibited fusion at the L3–4 level and 34 patients, at the L4–5 level. The fusion status was assessed using plain radiographs. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scores. Nonunion was noted in 26% (11/42) of the patients. There were no statistically significant differences between the groups exhibiting union and nonunion with respect to age, sex, preoperative JOA score, or preoperative lumbar instability. The union group achieved better operative results than the nonunion group at the 5-year and final follow-up (P = 0.006 and 0.008, respectively) although there was no significant difference in the percent recovery at 1 and 3-year follow-up (P = 0.515 and 0.506, respectively). A stepwise regression analysis revealed that the best combination of predictors for percent recovery at the time of final follow-up included the fusion status and the presence of comorbid disease. The results indicate that the fusion status following PLF is a critical factor influencing the long-term but not short-term operative results in the treatment of LCS with degenerative spondylolisthesis.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Similar content being viewed by others


  1. Boden SD (2002) Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine 27:S26–S31. doi:10.1097/00007632-200208151-00007

    Article  PubMed  Google Scholar 

  2. Carreon LY, Djurasovic M, Glassman SD et al (2007) Diagnostic accuracy and reliability of fine-cut CT scans with reconstructions to determine the status of an instrumented posterolateral fusion with surgical exploration as reference standard. Spine 32:892–895. doi:10.1097/01.brs.0000259808.47104.dd

    Article  PubMed  Google Scholar 

  3. Chen Q, Baba H, Kamitani K et al (1994) Postoperative bone re-growth in lumbar spinal stenosis. A multivariate analysis of 48 patients. Spine 19:2144–2149

    Article  CAS  PubMed  Google Scholar 

  4. Dupuis PR, Yong-Hing K, Cassidy JD et al (1985) Radiologic diagnosis of degenerative lumbar spinal instability. Spine 10:262–276. doi:10.1097/00007632-198504000-00015

    Article  CAS  PubMed  Google Scholar 

  5. Esses SI, Huler RJ (1992) Indications for lumbar spine fusion in the adult. Clin Orthop:87–100

  6. Fischgrund JS, Mackay M, Herkowitz HN et al (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812. doi:10.1097/00007632-199712150-00003

    Article  CAS  PubMed  Google Scholar 

  7. Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 73:802–808

    CAS  PubMed  Google Scholar 

  8. Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:354–364. doi:10.1097/00007632-198107000-00005

    Article  CAS  PubMed  Google Scholar 

  9. Izumida S, Inoue S (1986) Assessment of treatment for low back pain. Japanese Orthopaedic Association. J Jpn Orthop Assoc 60:391–394

    Google Scholar 

  10. Jonsson B, Annertz M, Sjoberg C et al (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: five-year follow-up by an independent observer. Spine 22:2938–2944. doi:10.1097/00007632-199712150-00017

    CAS  PubMed  Google Scholar 

  11. Kant AP, Daum WJ, Dean SM et al (1995) Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation. Spine 20:2313–2317. doi:10.1097/00007632-199511000-00009

    Article  CAS  PubMed  Google Scholar 

  12. Katz JN, Lipson SJ, Larson MG et al (1991) The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am 73:809–816

    CAS  Google Scholar 

  13. Kornblum MB, Fischgrund JS, Herkowitz HN et al (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 29:726–724. doi:10.1097/01.BRS.0000119398.22620.92

    Article  PubMed  Google Scholar 

  14. Mardjetko SM, Connolly PJ, Shott S (1994) Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993. Spine 19:2256S–2265S. doi:10.1097/00007632-199410151-00002

    Google Scholar 

  15. Nagaosa Y, Kikuchi S, Hasue M et al (1998) Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study. Spine 23:1447–1451. doi:10.1097/00007632-199807010-00004

    Article  CAS  PubMed  Google Scholar 

  16. Park P, Garton HJ, Gala VC et al (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:1938–1944. doi:10.1097/01.brs.0000137069.88904.03

    Article  PubMed  Google Scholar 

  17. Polly DW Jr, Santos ER, Mehbod AA (2005) Surgical treatment for the painful motion segment: matching technology with the indications: posterior lumbar fusion. Spine 30:S44–S51. doi:10.1097/01.brs.0000174529.07959.c0

    Article  PubMed  Google Scholar 

  18. Postacchini F, Cinotti G (1992) Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 74:862–869

    CAS  Google Scholar 

  19. Resnick DK, Choudhri TF, Dailey AT et al (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion. J Neurosurg Spine 2:653–657

    Article  PubMed  Google Scholar 

  20. Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine 30:S71–S81. doi:10.1097/01.brs.0000155579.88537.8e

    Article  PubMed  Google Scholar 

  21. Tajima N, Chosa E, Watanabe S (2004) Posterolateral lumbar fusion. J Orthop Sci 9:327–333. doi:10.1007/s00776-004-0773-8

    Article  PubMed  Google Scholar 

  22. Trief PM, Ploutz-Snyder R, Fredrickson BE (2006) Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine 31:823–830. doi:10.1097/01.brs.0000206362.03950.5b

    Article  PubMed  Google Scholar 

  23. Zheng F, Sandhu HS, Cammisa FP Jr et al (2001) Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery. J Spinal Disord 14:518–521. doi:10.1097/00002517-200112000-00011

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Takahiro Tsutsumimoto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsutsumimoto, T., Shimogata, M., Yoshimura, Y. et al. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J 17, 1107–1112 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words