Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11–13 years

Abstract

Introduction and materials We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; failed back syndrome after one to five discectomies; and failed back syndrome after one to three laminectomy operations (Groups 1-4, respectively). Methods They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated. Results The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1 %. The reoperation rate was 15.1 % (7.5 % due to adjacent segment disease).Conclusion Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0 %, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0 %. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for [80 % of patients, but varied among groups.

ALIF versus TLIF for Post-Discectomy Syndrome

“…Complications of both fusion types were comparable and in line with the literature. [33][34][35] The anterior approach is inevitably linked to additional morbidity, reflected in our series by one patient who required revision surgery for postoperative abdominal wall insufficiency. However, we assume that the two cases of bone fragment dislocation and cage migration resulting in nerve root injury and revision surgery in the TLIF group would not have happened in ALIF patients.…”

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

“…Also, Roy et al 22 found that transformational epidural steroid significantly reduced pain NRS and disability scores until 12 months after injection. Moreover, Turunen et al 23 examined the long-term outcome of lumbar transpedicular instrumented posterolateral fusion in patients with varied diagnoses and reported the greatest improvement in ODI and pain VAS values was in patients who had degenerative spondylolisthesis with spinal stenosis, followed by patients who had FBSS after one to three laminectomy operations, while the lowest was in patients who had adult isthmic spondylolisthesis, and they concluded that long-term outcomes of lumbar instrumented posterolateral fusion were satisfactory for > 80% of patients.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…The advocates of disc replacement, and its importance in preventing what they see as the great disadvantage of fusion, namely adjacent segment degeneration would find the paper by Turunen [54] of interest. It is a retrospective review of 106 patients operated upon between 1992 and 1997 using an instrumented posterolateral fusion the authors identified four groups, degenerative spondylolisthesis with spinal stenosis, adult listhetic spondylolisthesis, failed back syndrome after one to five discectomies, and failed back syndrome after one to three laminectomies.…”