Functional and Radiological Outcomes of 360° Fusion of Three or More Motion Levels in the Lumbar Spine for Degenerative Disc Disease

Study Design. This is a single-center, multisurgeon, retrospective study of radiologic and functional outcome measures at a minimum 2-year follow-up. Objective. We studied the radiologic and functional outcomes following 3 or more motion segment fusions of the lumbar spine for low back pain due to multilevel degenerative disc disease. Summary of Background Data. Good functional outcomes have been reported for 1 or 2-level fusions, but there are no reports dealing specifically with 3 or more level fusions. Methods. A total of 80 adult patients met the inclusion/exclusion criteria of multilevel (3 or more motion segments) 360 fusion for lumbar degenerative disc disease, failed nonoperative treatment for at least 1 year, no previous lumbar fusion, no fracture, tumor or infection of the spine, completed preoperative and postoperative functional questionnaires including SF-36 (n = 80), Oswestry (n = 69), Roland Morris (n = 68), and radiologic evaluation of fusion solidity with a minimum follow-up of 2 years. Results. The average patient age was 57 years (range, 27-81). The mean follow-up was 4 years (2-7). On average, patients had fusion of 4 motion segments (range, 3-8 levels). Solid arthrodesis at the first surgery was achieved in 65/80 (81%). Adjacent segment degeneration was noted in 11 patients. Of these, 5 had undergone an extension of their fusion within the study period. There were no deaths or neurologic complications. Deep wound infection occurred in 2 patients, neither requiring implant removal. The Oswestry Disability Index scores improved from 49.8 to 35.1 (29.5%) (P < 0.001). The Roland Morris scores improved from 17.6 to 12.2 (30.7%) (P < 0.001). For the SF-36 scales, significant (P < 0.001) improvement was seen in all scales except Role Emotional scores and Mental Composite Scales. Conclusion. The surgical treatment of lumbar degenerative disc disease by 360 fusion should be considered for properly selected patients. The goal of surgery is reduction, not elimination of disability.