Abstract
Objectives: The aim of this study was to determine the outcome of posterior lumbar fusion performed using an intrasegmental pedicle screw device.
Design: Prospective Case Series.
Subjects: 83 consecutive patients underwent posterior lumbar fusion for the intrasegmental pedicle screw device between October 1998 and November 2001. The mean age was 46.8 (range 17–86) and 46 were male and 37 female. 40 patients had a single intervertebral level fusion, 34 two level and 7 three level. 23 patients had undergone previous spinal surgery and 29 were smokers.
Outcome Measures: Fusion status was assessed using radiographs (lateral, AP and in the plain if the intervertebral disc). To be judged as fused, there had to be an absence of metalwork failure, no pedicle screw loosening and fusion at all levels if a multi-level fusion.
Patient outcome was assessed by means of a visual analogue scale (VAS) for pain, SF36 health assessment questionnaire, a patient subjective outcome assessment, employment status and analgesic usage.
Results: Patients were followed up for a minimum of one year. Fusion was successfully achieved in 80 (96%) patients.
The mean VAS reduced by 2.2 points from 8.2 to 5.9 (p=0.007). There was a significant improvement in all the physical component scores of the SF36. The subjective outcome was either excellent or good in 65% of patients. Analgesia usage reduced in 71% of patients. 4 patients underwent further surgery. One patient died in the post operative period. There was no significant difference in the fusion rate in smokers compared to non smokers, or those that had undergone previous spinal surgery. The subjective outcome was either excellent or good in 59% of smokers, but only 37% in those that had undergone previous surgery.
Conclusions: We believe that our results demonstrate that the use of an intrasegmental pedicle screw device can facilitate high fusion rates with good clinical outcomes in most patients. The fusion rate does not appear to be effected by smoking, or previous spinal surgery.
The abstracts were prepared by Mr Peter Millner. Correspondence should be addressed to Peter Millner, Consultant Spinal Surgeon, Orthopaedic Surgery, Chancellor Wing, Ward 28 Office Suite, St James’ University Hospital, Beckett Street, Leeds LS9 7TF.
