Comparison of interbody fusion approaches for disabling low back pain

Study Design. This is a study comparing two groups of patients surgically treated for disabling low back pain. One group was treated with lumbar anteroposterior fusion (360 degrees fusion), the other with posterior lumbar interbody fusion and an interbody fixation device. Objectives. To determine which approach provided the best and most cost-effective outcome using similar patient selection criteria. Summary of Background Data. Others have shown that certain patients with disabling low back pain benefit from lumbar fusion. Although rarely reported, the costs of different surgical treatments appear to vary significantly, whereas the patient outcome may vary little. Methods. Since 1991, 75 patients have been treated. Starting in 1993, posterior lumbar interbody fusion-BAK was offered to patients as an alternative to 360 degrees fusion. The treating surgeon reviewed the cases. The interbody fixation device used (BAK; Spine-Tech, Inc., Minneapolis, MN) was part of a Food and Drug Administration study. Patient selection criteria included examination, response to conservative therapy, imaging, psychological profile, and discography. North American Spine Society outcome questionnaires, BAK investigation data, radiographs, chart entries, billing records and patient interviews were the basis for assessment. Results. Age, sex, compensable injury history, and history of previous surgery were similar. Operative time, blood loss, hospitalization time, and total costs were significantly different. There was a quicker return to work and closure of workers' compensation claims for the posterior lumbar interbody fusion-BAK group. Patient satisfaction was comparable at last follow-up. Conclusions. Posterior lumbar interbody fusion-BAK achieves equal patient satisfaction but fiscally surpasses the 360 degrees fusion approach. Today's environment of regulated medical practice requires the surgeon to consider cost effectiveness when performing fusion for low back pain.