Jp. Steib et al., Results of lumbar and lumbosacral fusion: clinical and radiological correlations in 113 cases reviewed at 3.8 years, REV CHIR OR, 86(2), 2000, pp. 127-135
Citations number
41
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine
Journal title
REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L APPAREIL MOTEUR
Purpose of the study
Spinal fusion requires the use of hardware for reduction and stabilization.
We present the clinical and radiological behavior of a population of patie
nts with lumbar and lumbosacral spinal fusion.
Materials and methods
Between 1990 and 1992, 113 patients were operated for lumbar and lumbosacra
l fusion. Mean age of the population was 43 years and mean follow-up was 3.
8 years. Most of the fusions were L4-S1 fusions. 56% of the patients had a
previous surgery. Thirteen patients in the series were reoperated and analy
zed separately. In the majority of the cases, the indication for surgery wa
s back pain with or without leg pain. Diagnoses were : spondylolisthesis, d
iscopathy, scoliosis, and pseudoarthrosis. The spine was fused and reduced
using two lordotic rods. Peroperative and postoperative lordosis were calcu
lated on X-rays. Clinical results were analyzed with the Beaujon-Lassale sc
ore.
Results
Mean improvement was significantly better for spondylolisthesis than for ot
her pathologies (85.6% versus 77.1%). Returning to work was possible for 85
.5% of those with improvement and was not possible for 69.8%. The gain achi
eved in lordosis at surgery was lost at last follow-up. The lordosis of the
construct appeared to protect against the development of discopathies abov
e and below the construct. Discopathis led to a poor score. The rate of non
-union was 7.9%, the rate of repeated surgery 6.1% and the rate of hardware
removal 23.8%. At last follow-up, improvement was achieved in 45.6% of the
13 patients of the series who had repeat surgery.
Discussion
The results in our series are similar to those reported by others. Lumbar l
ordosis is an important factor : if lost, more interbody fusions may be sub
sequently required. Diagnosis of non-union is difficult and reoperation is
the only sure manner to prove it by applying distraction-compression manoeu
vres on the screws. All non-unions presented were symptomatic; incidence in
the series was thus probably higher. Non-union and reoperation with a long
er fusion are perhaps correlated with insufficient elasticity in the osteos
ynthesis. Optimal rod elasticity is a factor which remains to be defined.
Conclusion
Clinical results of lumbar and lumbosacral fusions are not unsatisfactory,
but in our series almost one patient out of three had to be reoperated. One
of the reasons for so many reoperations is certainly hardware rigidity Har
dware was not removed without testing the fusion as this is the only means
of sure diagnosis of non-union. Reoperation should not be considered a fail
ure in this difficult surgery of back pain which requires long-term surgica
l follow-up.