Abstract
Introduction: Spinal fusion for the treatment of low back pain (LBP) remains controversial. Surgeons must evaluate outcomes to justify these procedures.
Aim: To examine the subjective and objective outcomes in patients undergoing posterolateral spinal fusion for degenerative spondylosis and LBP using pedicle screw instrumentation.
Method: A prospective, independent assessment of subjective (patient assessment of outcome, procedure worth, procedure repeatability, and pain scores) was carried out. Objective measures (Low Back Outcome Score (LBOS), Prolo Functional/Economic Score, medication requirements and employment status) were also assessed prospectively.
Results: Seventy-one percent of the patients rated their outcome successful and 86% rated it worthwhile and would repeat the experience. Pain scores were improved in 78.6%. The LBOS improved from 18 to 40 (p< 0.05), yet only 28.6% of patients reached good or excellent scores. The Prolo score improved from 4.2 to 6.4 with 46% good or excellent outcomes. Pain medication requirements reduced by 75%. Twenty-three patients were insured by the ACC and 16 of these were on earnings related compensation (ERC) before surgery. At the time of the follow-up 14 were working full-time, five were working part-time with an income top up from the ACC, and four remained on ERC. Return to work rates were inversely proportional to duration of time off work prior to surgery.
Conclusions: Patient satisfaction was acceptable for this form of surgery particularly considering the magnitude of preoperative disability. The improvement in functional scores was significant yet failed to reach good or excellent levels for the majority. Despite this return to work rates were high for this class of patient justifying careful use of fusion as an intervention in selected patients with intractable LBP.
The abstracts were prepared by Professor Alan Thurston. Correspondence should be addressed to him at the New Zealand Orthopaedic Association, PO Box 7451, Wellington, New Zealand.
