Implications of Number of Fused Levels in the Outcome of Patients with Lumbar Degenerative Diseases

Abstract

Introduction Patients with symptomatic lumbar degenerative disease can have one or more intervertebral disc involved according to several factors, such as age, smoking, weight, and profession. The objective of this study was to evaluate the outcome of patients with degenerative disease submitted to lumbar spinal fusion considering the number of levels fused. Patients and Methods Prospective comparative study in patients that were submitted to fusion of one (G1), two (G2), or three or more (G3) levels with a 6-month follow-up. The patients were evaluated preoperatively, at 30 days and 6 months postoperatively with the following validated instruments: NRS, ODI, HAD, and IDB. Comparisons among the groups were done with ANOVA and chi-square tests. The post hoc analyses were conducted with Bonferroni test. Results A total of 65 patients (G1 = 21; G2 = 25; and G3 = 19) were studied. The mean age was greater in G1 and lower in G3 ( p = 0.024). There was no difference among the groups regarding gender, previous surgery, evolution of the symptoms, and work compensation. The duration of surgery was longer, there was more bleeding and a greater incidence of postoperative complications ( p = 0.022) in G3 group ( p < 0.05). The intensity of pain was higher in G3 in the postoperative evaluation at 30 days, but that difference disappears postoperatively, within 6 months. There was no difference concerning hospital stay, transoperative complications, disability (ODI), depression and anxiety (HADS), and satisfaction among the groups ( p = 0.140). Conclusion There was no difference in relation to the pain, disability, depression and anxiety, and postoperative satisfaction among the groups. The patients with three or more fused levels were older and had higher rates of postoperative complications.