Abstract
Introduction: Hypothesis:- Posterior lumbar interbody fusion (PLIF) produces improvement in the MOS Short Form 36 (SF36) scores comparable to that seen in total hip replacement.
Current consensus holds the surgical treatment of lower back pain as less effective or predictable than interventions performed in most other orthopaedic subspecialties. Detailed clinical and economic outcome studies are vital to justify its use in routine practice. This prospective study presents medium to long-term clinical outcome scores for PLIF which are compared with those of an operation that might be considered a modern orthopaedic gold-standard: total hip arthroplasty.
Methods: The authors present 100 consecutive PLIF operations performed by the senior author between 1997 and 2004. SF36, Oswestry Disability Index (ODI), Visual Analogue Scores (VAS) and walking distances were prospectively collected and analysed in the post-operative period. Results were compared to the SF36 healthy population norms and with the outcome scores of standard total hip replacement available in the literature.
Results: The mean pre-operative ODI was 49. 12 months following surgery this improved to 22. All outcomes as measured by SF36 improved following surgery. The VAS for back pain improved from 8.5 pre-operatively to 3.21 post-operatively. Leg pain improved from 6.98 to 2.85. Improvements in the SF36 scores were similar to those seen in hip arthroplasty.
Discussion: The hypothesis has been proven. The gains in function following spinal fusion are comparable with those seen in hip arthroplasty. In the authors’ opinion PLIF is an effective procedure in an appropriately selected patient population.
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
