Functional outcome after posterolateral spinal fusion using pedicle screws: comparison between primary and salvage procedure

Abstract

Lumbar spinal fusion is a commonly performed surgical procedure, yet both the indications for its performance and its results remain controversial. It is generally believed that apart from situations where obvious measurable instability exists, a repeat surgical procedure such as spinal fusion does not improve the functional outcome in more than an average of 50% of cases. The aim of this study was to analyse functional outcome after posterolateral lumbar or lumbosacral spinal fusion, comparing primary and salvage procedures. It was designed as a prospective case/referent study with a 2-year follow-up. A total of 39 patients underwent a short posterior fusion with Cotrel-Dubousset (CD) pedicle screw fixation after earlier surgery of the lumbar spine. Two patients were erroneously omitted from the study at the index, so 37 patients were included in the salvage group. In the same period, 69 patients underwent lumbar fusion with pedicle screw fixation (CD) as primary surgery (referent group). Functional outcome was assessed by means of the Dallas Pain Questionnaire preoperatively and 1 and 2 years postoperatively. Fusion rates were determined by ordinary X-ray evaluation by two independent observers. Patients who had undergone previous spinal surgery had a significant improvement in functional outcome in terms of daily activity, work and leisure-time activities and anxiety/depression. With regard to social functioning, a significantly inferior outcome was found after the salvage procedure. The return-to-work rates at 2 years after surgery were 50% in the salvage group and 53% in the referent group. There was a significant correlation between radiological evaluation of the fusion mass and the functional outcome. The fusion rate was 76% in the salvage group and 72% in the referent group. This study demonstrates that a posterolateral spinal fusion can be effectively used as a salvage procedure. The functional and radiological outcome of the patients with revision surgery did not differ from those of the group of patients who underwent primary surgery. There was, however a clear indication of inferior social functioning after revision surgery.

Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

“…However, more recent studies have shown that a significant number of patients with ASD often need re-operation in view of their symptoms [5,25,27,31]. It is known that re-operations following spinal fusion do not always carry a good prognosis and the success rate seems to decrease with each successive surgical intervention [4,11,16]. Hence, it is appropriate to study the factors that may cause an increased incidence of ASD.…”

“…This becomes symptomatic in many cases and may need re-operation. It is well known that re-operations following lumbar fusions do not always carry good results and that the percentage of good results decreases with each revision surgery [4,11,16]. It is therefore essential to minimize the possibility of re-operation as much as possible.…”

Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology: an international survey of spine surgeons

“…9,39,41,49 In general, reoperations above previous lumbar spine fusions are undesirable, as success rates have been reported to decrease after each subsequent operative intervention. 7,13,17 Mild-tomoderate sagittal plane deformity can be difficult to detect on physical exam alone since patients with a positive SVA can often maintain an upright posture and horizontal vi- Proximal junctional kyphosis (PJK) is a subset of ASP that attracts much attention in the spine deformity literature. PJK is defined as an increase in kyphosis between the caudal endplate of the uppermost instrumented vertebra (UIV) and the cephalad endplate of the vertebra 2 segments cranial to the UIV by > 10° compared to preoperative imaging.…”

Radiographic evaluation of posterolateral lumbar fusion for degenerative spondylolisthesis: long-term follow-up of more than 10 years vs. midterm follow-up of 2–5 years

“…Lumbar arthrodesis has been commonly performed for the treatment of low back pain caused mainly by degenerative disorders of the lumbar spine such as DS [3,4,5,6,7,8]. The goal of spinal fusion is to obtain a solid arthrodesis [5,7,8,9]. Posterolateral fusion (PLF) in the lumbar spine using autogenous bone graft with or without instrumentation has been the most commonly performed of several surgical techniques available for spinal arthrodesis [1,3,4,5,7,8,9,10].…”