OUTCOME OF INSTRUMENTED SPINAL FUSION FOR CHRONIC LOW BACK PAIN: REVIEW OF 100 PATIENTS

Instrument Spinal Fusion

Abstract

Objective: Objective of this study was to evaluate the outcome of instrumented spinal fusion in selected patients with Chronic Low Back Pain (CLBP) in our setup. Study Design: Quasi-experimental study. Place and Duration of Study: Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan. Jan 2002 to Dec 2007. Patients and Methods: Consecutive first one hundred patients were selected from spine unit database that underwent instrumented spinal fusion for chronic low back pain lasting more than one year, due to degenerative disease of spine. Results: Average age was 42 years. There were 62 males and 38 females. Diagnosis included; spinal stenosis (26%), failed disc surgery (22%), spondylolisthesis (19%), degenerative disc disease (17%), and instability (16%). Operations performed; Pedicle Screw Fixation (PSF) with Postero-lateral Fusion (PLF) in 3% patients. Trans Laminar Facet Screw (TLFS) with PLF in 24% patients. Anterior Lumbar Inter-body Fusion (ALIF) in 9% patients. Posterior Lumbar Inter-body Fusion (PLIF) in 40% patients and Trans-foraminal Lumbar Inter-body Fusion (TLIF) in 24% patients. Average follow up was for 30 months. 86% patients had full spinal fusion. 71% patients were fully satisfied with treatment, 28% were partially satisfied. Post-operatively, on average, visual analogue scale (VAS) showed 48 points significant improvement and Oswestry Disability Index (ODI) showed 53 points significant improvement.

Conclusion: Instrumented Spinal Fusion is effective in our set up for relieving symptoms and improving functional outcome in selected patients with debilitating Chronic Low Back Pain due to degenerative disease of spine. Single fusion technique is not ideal for all types of patients and surgeon has to be versatile and trained in using different fusion techniques as the situation demands. Keywords: Instrumented Spinal Fusion, Chronic Low Back Pain, Anterior Lumbar Interbody Fusion, Posterior Lumbar Interbody Fusion, Transforaminal Lumbar Interbody fusion, Translaminar Facet Screws, Visual Analogue Scale, Oswestry Disability Index.