Objectives: The aim of this study was to determine the outcome of posterior lumbar interbody fusion using an intrasegmental pedicle screw device in a series of patients with symptomatic spondylolisthesis.

Design: Prospective Case Series.

Subjects: 34 consecutive patients underwent posterior lumbar fusion for symptomatic spondylolisthesis using an intrasegmental pedicle screw device between December 1998 and January 2002. The mean age was 48.6 (range 27–84) and 16 were male and 18 female. 22 patients had a spondylolisthesis at the L5/S1 level, 10 at the L4/5 level, 1 at the L3/4 level, 1 at the L2/3 level. 17 patients had a grade 1 slip, 16 grade 2, and 1 grade 3. 22 patients had a single intervertebral level fused, 10 two levels and 2 three levels.

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, 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: Fusion was successfully achieved in 33 (97%) patients.

The mean VAS reduced by 3.2 points from 8.3 to 5.1 (p=0.0001). There was a significant improvement in all the physical component scores of the SF36. The subjective outcome was either excellent or good in 24 (71%) patients. Of the 26 patients working prior to surgery, 20 (77%) returned to work. Analgesia usage reduced in 21 (61%) patients.

One patient died in the post operative period.

Conclusions: Our study supports the view that good clinical outcomes can be achieved by posterior interbody fusion of symptomatic spondylolisthesis. This particular intrasegmental device enables a safe, simple technique for reduction and fusion of symptomatic spondylolisthesis.

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.

Introduction: Abnormal pain drawings have been shown in some studies to correlate well with psychological characteristics predicting poor outcome in spinal procedures. Our study evaluated whether pain drawings are a useful predictive tool for outcome following Intradiscal Electrothermal Therapy (IDET).

Method: 56 Patients underwent IDET for chronic discogenic lumbar pain as demonstrated by MRI and provocative discography. They were assessed pre and post operatively. Preoperatively patients were assessed by means of a questionnaire. Pain was measured using a visual analogue scale (VAS), a pain drawing was completed and demographic details and employment status were recorded. Post IDET patients were followed up by means of a postal questionnaire. The same details were recorded, in addition to which patients completed a Short Form 36 UK Version 1 and a subjective outcome assessment.

Pain drawings were classified as organic or non-organic according to the principle described by Mann et al.

Results: 46 (80.7%) patients were successfully followed up. Mean age was 41.2 years (Range 16–76), 27 were female and 19 male. 73.9% of pain drawings were classified as organic and 26.1% as non-organic. The pain diagram was a good predictive tool for outcome following IDET. Patients with “organic” pain drawings showed an improvement in mean pain VAS (Pre-6.7, Post 5.9), high patient satisfaction (Better 67.6%, Same 11.8%, Worse 20.6%), and higher physical component scores of the SF36 (Physical 64.1, Physical Role 45.6, Pain 54.0) compared to the “non-organic” group who demonstrated a deterioration in mean pain VAS (Pre-6.5, Post 8.2), low patient satisfaction (Better 8.3%, Same 58.3%, Worse 33.3%), and lower physical component scores of the SF36 (Physical 38.3, Physical Role 20.8, Pain 26.5).

Conclusion: We believe that our study demonstrates that a pre procedure pain diagram can be reliably used as a tool to predict outcome following IDET.