Abstract
PurposeDespite the rapid increase in instrumented spinal fusions for a variety of indications, most studies focus on short-term fusion rates. Long-term clinical outcomes are still scarce and inconclusive. This study investigated clinical outcomes > 10 years after single-level instrumented posterolateral spinal fusion for lumbar degenerative or isthmic spondylolisthesis with neurological symptoms.MethodsCross-sectional long-term follow-up among the Dutch participants of an international multicenter randomized controlled trial comparing osteogenic protein-1 with autograft. Clinical outcomes were assessed using the Oswestry Disability Index (ODI), EQ-5D-3L and visual analogue scale (VAS) for leg and back pain, as well as questions on satisfaction with treatment and additional surgery.ResultsThe follow-up rate was 73% (41 patients). At mean 11.8 (range 10.1–13.7) years after surgery, a non-significant deterioration of clinical outcomes compared to 1-year follow-up was observed. The mean ODI was 20 ± 19, mean EQ-5D-3L index score 0.784 ± 0.251 and mean VAS for leg and back pain, respectively, 34 ± 33 and 31 ± 28. Multiple regression showed that diagnosis (degenerative vs. isthmic spondylolisthesis), graft type (OP-1 vs. autograft) and 1-year fusion status (fusion vs. no fusion) were not predictive for the ODI at long-term follow-up (p = 0.389). Satisfaction with treatment was excellent and over 70% of the patients reported lasting improvement in back and/or leg pain. No revision surgeries for non-union were reported.ConclusionThis study showed favourable clinical outcomes > 10 years after instrumented posterolateral spinal fusion and supports spondylolisthesis with neurological symptoms as indication for fusion surgery.
Highlights
IntroductionThe rates of instrumented spinal fusion surgery increased markedly over the past decades, succeeded by growing evidence of especially short- and mid-term treatment effects for specific indications including lumbar spondylolisthesis
The rates of instrumented spinal fusion surgery increased markedly over the past decades, succeeded by growing evidence of especially short- and mid-term treatment effects for specific indications including lumbar spondylolisthesisAnother area of controversy is the relationship between radiographic fusion and clinical outcomes [12,13,14]
Among patients with degenerative lumbar spondylolisthesis treated with decompression and uninstrumented posterolateral fusion, solid arthrodesis appeared only beneficial for longterm clinical outcomes [15, 16]
Summary
The rates of instrumented spinal fusion surgery increased markedly over the past decades, succeeded by growing evidence of especially short- and mid-term treatment effects for specific indications including lumbar spondylolisthesis. Another area of controversy is the relationship between radiographic fusion and clinical outcomes [12,13,14]. In the presence of rigid instrumentation the necessity of a solid fusion within the first years can be debated. This emphasizes the need for long-term evaluations. Secondary outcomes included pain experience, quality of life, satisfaction with treatment and reoperation rate
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