Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes?
World Neurosurg. 2018 Apr 06;:
Authors: Prolo LM, Oklund SA, Zawadzki N, Desai M, Prolo DJ
Abstract
BACKGROUND: Since 1980s numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of allo-PLIF.
METHODS: Between 1981-2006 321 patients ages 12-80, underwent 339 one- or two-level allo-PLIFs for degenerative instability and were followed 1-28 years. Fusion status was determined by radiographs and as available, by CT scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale.
RESULTS: 308 of the 321 patients were followed postoperatively (average 6.7 years, range 1-28); 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, p=0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores following initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (p=0.001). A positive association between a patient characteristic and outcome was observed only with age 65 and greater; whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to low back, or industrial injuries. Total complication rate was 7%.
CONCLUSIONS: With three decades of follow-up we found successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone.
PMID: 29631080 [PubMed - as supplied by publisher]
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