Abstract
Introduction: Smoking has been associated with a poor outcome from lumbar spine fusion surgery. We present our results using an intrasegmental pedicle screw device, which seems to achieve high fusion rates in patients who smoke.
Methods: Between October 1998 and July 2001, 67 patients underwent lumbar interbody fusions using an intrasegmental pedicle screw device. Pre operative Short Form 36 (SF36) scores, pain visual analogue scores (VAS) and patient demographics were recorded. Postoperative follow up was performed clinically and radiographically until fusion was judged to have occurred. Radiographic criteria for fusion were: evidence of a fusion mass at all fused levels, absence of pedicle screw loosening and no metalwork breakage. Patients who did not meet this criteria were classified as either a pseudarthrosis, or indeterminate. Patients completed a questionnaire on attendance at clinic, or by post if discharged. This included an SF36, Oswestry Disability Index (ODI), employment status, analgesic use and patient satisfaction assessment.
Results: 67 patients (38 male and 29 female) were successfully followed up. The mean age was 45.2 (range 17–86). Mean follow-up was 21.7 months (range 12–43 months). 36 posterolateral fusions and 31 combined posterior lumbar interbody/posterolateral fusions were performed. 22 patients were smokers and 45 non-smokers or ex-smokers at the time of surgery. Fusion rates were similar in smokers (83%) and non-smokers (80%). There was an improvement in mean VAS in both groups (Smoker/Non Smokers: Pre VAS 8.0/8.1 Post VAS 6.5/5.8). All SF36 physical component scores improved in both groups, although the improvement was slightly greater in the non-smoking group. Patient satisfaction was also similar in the two groups (Smoker/ Non-smokers: Pain “Much better” or “A little better” 58.6%/61/6%, Satisfied with outcome 72%/69%)
Conclusions: We believe that our results demonstrate that the use of an intrasegmental pedicle screw device can facilitate high fusion rates in both smokers and non-smokers.
Correspondence should be addressed to the editorial secretary: Dr Charles Pither, c/o British Orthopaedic Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
