Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria

Abstract

Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instrumented posterolateral fusion (PLF) is one of the options employed and has a reduced cost owing to the absence of the inter body cage used in inter body fusion techniques. The objective of this study was to assess posterolateral fusions in our center within a developing country with poor health insurance coverage as an effective treatment modality in degenerative lumbosacral spine disease, without the added cost of an interbody fusion cage. This was a retrospective study carried out in Jos, Nigeria covering a two year period from July 2015 to June 2017. Patients with degenerative spine diseases who had been on conservative methods of treatment for more than six months with no significant improvement were recruited for the study. Data was obtained from the case records of the patients the patients were assessed for the indications for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10) and the complications of the procedure. Data was analyzed using the epi info statistical software. 13 patients had Posterolateral fusion (PLF) within this period. The mean age was 61.4years ±10.7. A male female ratio of M:F 1:3.3. 8(61.5%) patients had multiple level disc degeneration and herniation, 2(15.4%) patients each had spinal canal stenosis and facet joint arthritis with instability and 1(7.7%) had degenerative spondylolisthesis. 9(69.2%) patients had 2 level fusion, 2 (15.4%) had 3 level fusion and 2(15.4%) had 1 level fusion. 6(46.2%) had a pain reduction by ≥ 8 points on the numeric pain scale, 6(46.2%) had reduction by 6-7 points and 1(7.7%) had reduction of 3-5 points. 92.6% of the patients had a pain reduction by more than 50%. Mean operative time was 203minutes, and mean transfusion requirement was 2.8 pints of blood. Complications noted were superficial surgical site infection 1 patient and dural tear 1 patient. Postero lateral fusion techniques are a safe and effective treatment modality in treating patients with degenerative lumbosacral spine disease. The non usage of the interbody fusion cage provides a cheaper alternative in posterolateral fusion and every modality to limit surgical site infection should be employed to limit increased cost from this complication.