Wednesday, October 30, 2001 4:42–5:25 pm Concurrent Session 2B: Lumbar Fusion Complications: 4:42 Residual lower extremity pain after decompression and posterolateral fusion for lumbar spondylolisthesis is often related to bone graft harvest

Abstract

Purpose of study: Posterior decompression and single-level posterolateral fusion is a well-accepted means of treating symptomatic grade 1–2 lumbar spondylolisthesis. Patients often present with lower extremity (LE) radiculopathy in addition to low back pain. This study was performed to determine whether residual LE pain is secondary to continued radiculopathy or to bone graft site harvest.Methods used: A total of 1,225 patients who had undergone lumbar surgery between 1997 and 2000 were retrospectively studied; 137 patients had undergone single-level posterolateral lumbar fusion for grade 1–2 spondylolisthesis that failed conservative treatment and were available for minimum 2-year follow-up. All patients had iliac crest bone graft site harvest contralateral to the side with the more severe radiculopathy preoperatively. Patients with continued LE discomfort were examined postoperatively to determine whether radicular signs were present and whether tenderness was present directly over the bone graft harvest site.of findings: Twenty-three patients (16.8%) continued to have some LE pain postoperatively. In 19 patients (82.6%) this pain was on the bone graft side. Postoperative physical examination demonstrated that in all 19 of these patients, radicular signs were absent, but tenderness localized to the buttock/posterior iliac crest area was present. Only 1 of the 23 patients had true residual radiculopathy. Fisher's exact test showed that the proportion of patients with residual LE pain and bone graft site findings was significantly greater than the proportion of patients with residual LE pain and radiculopathy (p<.01).Relationship between findings and existing knowledge: Excellent fusion rates and clinical outcomes have been reported for single-level posterior decompression and fusion for grade 1–2 spondylolisthesis. Although resolution of radicular symptoms is more reliable than relief of back pain, some patients still do complain of some LE pain postoperatively. Little is known about whether this is the result of true radiculopathy or the result of bone graft site pain.Overall significance of findings: Radiculopathy after single-level decompression and posterolateral fusion for lumbar grade 1–2 spondylolisthesis is rare. Patients with residual LE pain after this surgery most often have symptoms secondary to iliac crest bone graft harvest. The clinician must be aware of this and perform a thorough examination to prevent unnecessary reoperation for residual LE symptoms.Disclosures: No disclosures.Conflict of interest: No conflicts.