Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis |
| |
Authors: | Takahiro Tsutsumimoto Mitsuhiko Shimogata Yasuo Yoshimura Hiromichi Misawa |
| |
Institution: | (1) Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano 386-0603, Japan |
| |
Abstract: | 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. |
| |
Keywords: | Lumbar spinal fusion Posterolateral lumbar fusion Lumbar canal stenosis Degenerative spondylolisthesis |
本文献已被 SpringerLink 等数据库收录! |
|