Functional outcome after posterolateral spinal fusion using pedicle screws: Comparison between primary and salvage procedure

被引：17

作者：

Christensen F.B. ^{[1
]}

Thomsen K. ^{[2
]}

Eiskjær S.P. ^{[2
]}

Gelinick J. ^{[3
]}

Bünger C.E. ^{[2
]}

机构：

[1] Biomechanics Laboratory, Aarhus University Hospital, DK-8000 Aarhus C

[2] Spine Section, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus

[3] Department of Radiology, Aarhus University Hospital, Aarhus

来源：

European Spine Journal | 1998年 / 7卷 / 4期

关键词：

Dallas Pain Questionnaire; Functional outcome; Lumbar fusion; Pedicle screw; Reoperation; Revision surgery;

D O I：

10.1007/s005860050082

中图分类号：

学科分类号：

摘要：

Lumbar spinal fusion is a commonly performed surgical procedure, yet both the indications for its performance and its results remain controversial. It is generally believed that apart from situations where obvious measurable instability exists, a repeat surgical procedure such as spinal fusion does not improve the functional outcome in more than an average of 50% of cases. The aim of this study was to analyse functional outcome after posterolateral lumbar or lumbosacral spinal fusion, comparing primary and salvage procedures. It was designed as a prospective case/referent study with a 2-year follow-up. A total of 39 patients underwent a short posterior fusion with Cotrel-Dubousset (CD) pedicle screw fixation after earlier surgerY of the lumbar spine. Two patients were erroneously omitted from the study at the index, so 37 patients were included in the salvage group. In the same period, 69 patients underwent lumbar fusion with pedicle screw fixation (CD) as primary surgery (referent group). Functional outcome was assessed by means of the Dallas Pain Questionnaire preoperatively and 1 and 2 years postoperatively. Fusion rates were determined by ordinary X-ray evaluation by two independent observers. Patients who had undergone previous spinal surgery had a significant improvement in functional outcome in terms of daily activity, work and leisure-time activities and anxiety/depression. With regard to social functioning, a significantly inferior outcome was found after the salvage procedure. The return-to-work rates at 2 years after surgery were 50% in the salvage group and 53% in the referent group. There was a significant correlation between radiological evaluation of the fusion mass and the functional outcome. The fusion rate was 76% in the salvage group and 72% in the referent group. This study demonstrates that a posterolateral spinal fusion can be effectively used as a salvage procedure. The functional and radiological outcome of the patients with revision surgerY did not differ from those of the group of patients who underwent primary surgery. There was, however a clear indication of inferior social functioning after revision surgery.

引用

页码：321 / 327

页数：6

共 20 条

[1]

Carpenter C.T., Dietz J.W., Leung Y.K., Et al., Repair of a pseudarthrosis of the lumbar spine. A functional outcome study, J Bone Joint Surg [Am], 78, pp. 712-720, (1996)

[2]

Christensen F.B., Karlsmose B., Hansen E.S., Et al., Radiological and functional outcome after anterior interbody spinal fusion, Eur Spine J, 5, pp. 293-298, (1996)

[3]

Dworkin R.H., Gitlin M.J., Clinical aspects of depression in chronic pain patients, Clin J Pain, 7, pp. 79-94, (1991)

[4]

Finnegan W.J., Fenlin J.M., Marvel J.P., Et al., Results of surgical intervention in the symptomatic multiply-operated back patient. Analysis of sixty-seven cases followed for three to seven years, J Bone Joint Surg [Am], 61 A, pp. 1077-1082, (1979)

[5]

Fritsch E.W., Heisel J., Rupp S., The failed back surgery syndrome. Reasons, intraoperative findings, and long-term results: A report of 182 operative treatments, Spine, 21, pp. 626-633, (1996)

[6]

Gatchel R.J., Polatin P.B., Mayer T.G., The dominant role of psychosocial risk factors in the development of chronic low back pain disability, Spine, 20, pp. 2702-2709, (1995)

[7]

Hasenbring M., Marienfeld G., Kuhlendahl D., Et al., Risk factors of chronicity in lumbar disc patients. A prospective investigation of biologic, psychologic, and social predictors of therapy outcome, Spine, 19, pp. 2759-2765, (1994)

[8]

Herron L.D., Turner J., Clancy S., Et al., The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis, Spine, 11, pp. 847-850, (1986)

[9]

Junge A., Dvorak J., Ahrens S., Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes, Spine, 20, pp. 460-468, (1995)

[10]

Junge A., Frohlich M., Ahrens S., Et al., Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years' follow-up, Spine, 21, pp. 1056-1065, (1996)

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