Long-segment Posterolateral Fusion with Instrumentation of the Multi-level Spinal Stenosis: Long-term Followup over the 5 Years

Abstract

Purpose : To evaluate the long-term results, and to analyze the clinical and radiological of long-segment posterolateral fusion with instrumentation in multi-level spinal stenosis. Materials and Methods : A retrospective review was carried out on 62 patients, who had undergone long-segment posterolateral fusion with instrumentation for the treatment of multi-level spinal stenosis from June, 1990 to May, 1998 with a minimal follow up of 5 years. The clinical outcomes were evaluated using the Katz's classification and the Oswestry disability scoring system (ODI). The radiological were evaluated by monitoring the changes in the adjacent segments and the Lenke's grade for bony union. Results : The mean follow-up duration was 94 (61-156) months. There were 14 males and 48 females. The mean age was 58.7 (37-78) years. The mean number of fused segments per person were 3.97 (3-8) and the fusion techniques used in this study were either the fixed fusion for 60 cases or floating fusion for 2. 48 (77.4%) cases showed beyond 'satisfaction'. The mean ODI was 30.0 (6-88%), which means moderate disability. The ODI according to the number of fusion segments was checked for results. Good were observed in 25.8%, 33.6%, and 25.9% of patients with 3, 4 or more than 5 fusion segments, respectively. There was no statistical difference. Regarding the changes in the adjacent segments, disc space narrowing, traction spur, endplate sclerosis and vacuum phenomenon was observed in 25 (40.3%), 26 (41.9%), 22 cases (35.5%) and 7 cases (11.3%), respectively. 34 (55.0%) cases had more than one change in the adjacent segments but the ODI was 38.0% for good results and 25 (74.0%) cases were satisfied. In all cases except for one, bony union showed Lenke's A or B degree by radiographs. Pseudarthrosis was detected in 1 (1.6%) case. Conclusion : In the analysis of long-term clinical and radiological for multi-level spinal stenosis treatment, posterolateral fusion with instrumentation might be irrespective of the fusion level and the change in adjacent segment.