THE OUTCOME OF POSTEROLATERAL FUSION IN HIGHLY SELECTED PATIENTS WITHDISCOGENIC LOW-BACK-PAIN

Study Design. A prospective analysis of the clinical outcome of a cons ecutive series of patients treated with posterior lumbar arthrodesis. Preoperative data were collected retrospectively by chart review. Obje ctives. To measure by independent review the clinical outcome of poste rolateral intertransverse fusion as a treatment for discogenic low bac k pain in a highly selected group of patients. Summary of Background D ata. Although numerous studies have reported on the surgical managemen t of degenerative disc disease, they have been difficult to interpret because they lack patient-oriented outcome assessment and objective pa in measurement criteria, independent review, and include patients with diagnoses other than degenerative disc disease. Methods. Between 1991 and February 1993 all patients seen by a single surgeon, evaluated wi th magnetic resonance Imaging and discography; and treated with poster olateral lumbar fusion were reviewed by independent investigation. Out come was assessed in the areas of radiographic fusion, pain, function, and patient satisfaction. Results. Twenty-three patients (12 women, 1 1 men; 100% follow-up an average of 47 months after surgery [range, 24 -84 months]) met the inclusion criteria. Overall, 39% had a good or ex cellent result, 13% fair, and 48% poor. Nine of 10 patients receiving worker's compensation had poor result; four of five patients with radi ographic pseudarthrosis had a poor result. Statistically significant i mprovement in the visual analogue significant improvement in the visua l analogue scale was noted in the good and excellent group (P = 0.0001 ) and the fair group (P = 0.002) with no change in the poor group. Pat ients out of work more than 3 months before surgery tended to have poo r results. Overall, 56% of patients were extremely satisfied with the result of their surgery. Conclusions. Posterolateral intertransverse f usion can be used to successfully manage chronic discogenic back pain. However, patient selection remains a challenge, and successful outcom e appears to be limited in the subset of patients receiving worker's c ompensation and those chronically disabled. Prospective and randomized study with objective pain criteria, independent review, and patient-o riented outcome is recommended.