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P83. Does postoperative external support influence radiographic and clinical outcome in posterior lumbar interbody fusion (PLIF)
94S
Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S
from a perspective of quality of life (QOL). Since the ultimate goal of surgery for LDH is to improve QOL of the patients, it is imperative to assess the postoperative results using patient-based outcome measurements. PURPOSE: Long term outcomes in patients who underwent surgical treatments for LDH was assessed in order to elucidate the impact of residual LBP on their QOL. STUDY DESIGN/SETTING: A retrospective analysis on QOL in patients who underwent SD and ASF for LDH using various patient-based outcome measurements. PATIENT SAMPLE: Clinical records were detected for 177 patients who underwent surgical treatments for LDH (SD: 133 patients, ASF: 47 patients) in our hospital with a minimal follow-up of 5 years and who were under 70 years old at the final follow-up. Questionnaires were mailed to all of them and 94 patients who underwent SD (Group A) and 33 patients who underwent ASF (Group B) responded (survey rate: Group A 72.3%; Group B 70.2%). OUTCOME MEASURES: Incidence and degree of LBP within recent one year (5 point scale), patients’ satisfaction for surgery (5 point scale), concerns for future low back performance (4 point scale), Oswestry Disability Index (ODI), EQ-5D and SF-36 were investigated by mail. METHODS: Data of various measurement scales obtained from the two different treatment groups were entered into a spreadsheet in a personal computer and compared statistically using unpaired Student’s t-test. A P value under 0.05 was considered significant. RESULTS: Within recent one year, 27.6% of the patients in Group A and 39.4% in Group B had no LBP and there was no significant difference (3.9 points vs. 4.1) between the two groups. There were no significant differences with respect to patients’ satisfaction (4.5 vs. 4.4 points) and concerns for future low back performance (2.1vs. 2.1 points). There also were no significant difference in ODI (9.4% vs. 9.9), EQ-5D (0.875 vs. 0851) and and in all subscales of SF-36. Although average points in all subscales of SF-36 of Group A tended to be higher than those of Group B, those of both groups were lower than the national averages. CONCLUSIONS: For evaluation of QOL, there are two kinds of evaluation tools, profile-based scales that evaluate multi-dimensional aspects of patient’s health and more specific and focused preference-based scales. The profile-based scales include SF-36 as a generic assessment and ODI as a specific assessment for LBP, and the preference-based scales include EQ5D. All QOL scales in both groups were favorable. Although, the degree of LBP in group A was slightly higher than that in group A, the points in all subscales of SF-36 in group B tended to be lower than those in group A. These facts may partly due to the occurrence of postoperative complications such as ileus, thrombosis in some patients that affected the overall results in Group B. In order to reduce residual LBP, indication of fusion is often recommended. However, complications of fusion surgery could be devastating which may affect patient’s QOL for a long time. Since the residual LBP alone may not affect long-term QOL of patients, indication of fusion should, therefore, be selective. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.190 P83. Does postoperative external support influence radiographic and clinical outcome in posterior lumbar interbody fusion (PLIF) Takashi Ishida, MD, Tomoyuki Hashimoto, MD, Keiichi Shigenobu, MD, Masahiro Kanayama, MD, Fumihiro Oha, MD, Shigeru Yamane, MD; Hakodate Central General Hospital, Hakodate, Japan BACKGROUND CONTEXT: Interbody fusion cage have been increasingly utilized for lumbar spinal fusion and contributed to improve the fusion-site stability. However, external support after lumbar fusion surgery was at variance with hospital and the disagreement of its methods. PURPOSE: The objective of this study was to make a comparison about clinical results and radiographic evaluations between rigid lumbar orthosis and soft lumbar belt after single-level PLIF for lumbar degenerative disease. STUDY DESIGN/SETTING: A retrospective study.
PATIENT SAMPLE: A total of seventy eight consecutive patients associated with degenerative disease of the lumbar spine underwent single-level PLIF with Brantigan I/F cage and pedicle screw system with a minimum 1-year follow-up. There were 43 males and 35 females with an average of 59 years (14–78 years). Wearing the molded plastic thoracolumbosacral orthosis (TLSO) group (H group) were 41 cases, and soft lumbar belt (S group) were 37 cases. Seventy one cases were a mixture of local autograft and ceramic bone substitute, and six cases were local autograft alone. OUTCOME MEASURES: Radiographic evaluation included fusion rate and time to fusion, and alignment of fusion area and loss of correction. Clinical outcomes were evaluated the scoring system of the Japanese Orthopedic Association (JOA score; 29 points), visual analog scale (VAS) of low back and leg pain, and the period of external support wearing. METHODS: Radiographic evaluation and clinical outcomes were assessed preoperative, immediate postoperative, 4 weeks after surgery and the final follow-up. RESULTS: In radiographic evaluation, fusion rate was 95% of each group. The difference was not significant that fusion time in H group versus S group was 6.9 months versus 7.4 months. At the preoperative, immediate postoperative, 4 weeks after surgery and the final follow-up, lordosis of fusion level was 8.8, 13.5, 13.5, 10.6 degrees in the H group, otherwise, 11.2, 13.4, 12.1, 10.3 degrees in the S group. Thus, S group had a tendency to be more decreased of lordosis than H group at 4 weeks after surgery, but the difference was not significant of each group at the final follow-up. There was no statistical difference about JOA score and VAS between the two groups. The difference was not significant that period of external support wearing in H group versus S group was 3.9 months versus 3.7 months. Two cases (5.4%) in S group were changed of rigid lumbar orthosis due to be migrated the screw for severe osteoporosis at 2 weeks after surgery. CONCLUSIONS: Postoperative external supports are commonly used in spinal fusion surgery to restrict trunk motion, to increase intra-abdominal pressure, and consequently to relieve lumbar trunk muscle and spine loads. Although PLIF using interbody cages and pedicle screw fixation provides ideal postoperative stability thought three-point fixation theory, evidences were not found to determine which type of postoperative external support is required for successful radiographic and clinical outcomes. The current study investigated the effect of postoperative external support in radiographic and clinical outcomes in a single-level PLIF. The results suggested that wearing the molded plastic TLSO should be no longer necessary in a single-level PLIF. DISCLOSURES: Device or drug: Steffee VSP system. Status: Approved for this indication. Device or drug: Brantigan I/F cage. Status: Approved for this indication. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.191 P28. Minimal invasive transforaminal lumbar interbody fusion (TLIF) successful clinical and radiographic outcomes at two year follow up James Schwender, MD1, Kevin Foley, MD2, David Rouben, MD3, Langston Holly, MD4; 1Minneapolis, MN, USA; 2Image-Guided Surgery Research Center, Memphis, TN, USA; 3River City Orthopaedic Surgeons, Louisville, KY, USA; 4University of California, Los Angeles, Los Angeles, CA, USA BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) continues to gain popularity as a treatment of choice for lumbar spine fusion. This treatment avoids the need for anterior exposure of the lumbar spine to obtain circumferential fusion while providing direct decompression of the neural elements. PURPOSE: To evaluate a novel, minimally invasive approach to the unilateral TLIF procedure and report 2-year results. STUDY DESIGN/SETTING: This is a prospective, multicenter, study of consecutive surgical patients treated with the same surgical intervention. The METRx cannula system (Medtronic Sofamor Danek) is used unilaterally through a 22 or 26mm tubular retractor to allow for unilateral facetectomy followed by subtotal discectomy. Structural interbody support is
Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S
from a perspective of quality of life (QOL). Since the ultimate goal of surgery for LDH is to improve QOL of the patients, it is imperative to assess the postoperative results using patient-based outcome measurements. PURPOSE: Long term outcomes in patients who underwent surgical treatments for LDH was assessed in order to elucidate the impact of residual LBP on their QOL. STUDY DESIGN/SETTING: A retrospective analysis on QOL in patients who underwent SD and ASF for LDH using various patient-based outcome measurements. PATIENT SAMPLE: Clinical records were detected for 177 patients who underwent surgical treatments for LDH (SD: 133 patients, ASF: 47 patients) in our hospital with a minimal follow-up of 5 years and who were under 70 years old at the final follow-up. Questionnaires were mailed to all of them and 94 patients who underwent SD (Group A) and 33 patients who underwent ASF (Group B) responded (survey rate: Group A 72.3%; Group B 70.2%). OUTCOME MEASURES: Incidence and degree of LBP within recent one year (5 point scale), patients’ satisfaction for surgery (5 point scale), concerns for future low back performance (4 point scale), Oswestry Disability Index (ODI), EQ-5D and SF-36 were investigated by mail. METHODS: Data of various measurement scales obtained from the two different treatment groups were entered into a spreadsheet in a personal computer and compared statistically using unpaired Student’s t-test. A P value under 0.05 was considered significant. RESULTS: Within recent one year, 27.6% of the patients in Group A and 39.4% in Group B had no LBP and there was no significant difference (3.9 points vs. 4.1) between the two groups. There were no significant differences with respect to patients’ satisfaction (4.5 vs. 4.4 points) and concerns for future low back performance (2.1vs. 2.1 points). There also were no significant difference in ODI (9.4% vs. 9.9), EQ-5D (0.875 vs. 0851) and and in all subscales of SF-36. Although average points in all subscales of SF-36 of Group A tended to be higher than those of Group B, those of both groups were lower than the national averages. CONCLUSIONS: For evaluation of QOL, there are two kinds of evaluation tools, profile-based scales that evaluate multi-dimensional aspects of patient’s health and more specific and focused preference-based scales. The profile-based scales include SF-36 as a generic assessment and ODI as a specific assessment for LBP, and the preference-based scales include EQ5D. All QOL scales in both groups were favorable. Although, the degree of LBP in group A was slightly higher than that in group A, the points in all subscales of SF-36 in group B tended to be lower than those in group A. These facts may partly due to the occurrence of postoperative complications such as ileus, thrombosis in some patients that affected the overall results in Group B. In order to reduce residual LBP, indication of fusion is often recommended. However, complications of fusion surgery could be devastating which may affect patient’s QOL for a long time. Since the residual LBP alone may not affect long-term QOL of patients, indication of fusion should, therefore, be selective. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.190 P83. Does postoperative external support influence radiographic and clinical outcome in posterior lumbar interbody fusion (PLIF) Takashi Ishida, MD, Tomoyuki Hashimoto, MD, Keiichi Shigenobu, MD, Masahiro Kanayama, MD, Fumihiro Oha, MD, Shigeru Yamane, MD; Hakodate Central General Hospital, Hakodate, Japan BACKGROUND CONTEXT: Interbody fusion cage have been increasingly utilized for lumbar spinal fusion and contributed to improve the fusion-site stability. However, external support after lumbar fusion surgery was at variance with hospital and the disagreement of its methods. PURPOSE: The objective of this study was to make a comparison about clinical results and radiographic evaluations between rigid lumbar orthosis and soft lumbar belt after single-level PLIF for lumbar degenerative disease. STUDY DESIGN/SETTING: A retrospective study.
PATIENT SAMPLE: A total of seventy eight consecutive patients associated with degenerative disease of the lumbar spine underwent single-level PLIF with Brantigan I/F cage and pedicle screw system with a minimum 1-year follow-up. There were 43 males and 35 females with an average of 59 years (14–78 years). Wearing the molded plastic thoracolumbosacral orthosis (TLSO) group (H group) were 41 cases, and soft lumbar belt (S group) were 37 cases. Seventy one cases were a mixture of local autograft and ceramic bone substitute, and six cases were local autograft alone. OUTCOME MEASURES: Radiographic evaluation included fusion rate and time to fusion, and alignment of fusion area and loss of correction. Clinical outcomes were evaluated the scoring system of the Japanese Orthopedic Association (JOA score; 29 points), visual analog scale (VAS) of low back and leg pain, and the period of external support wearing. METHODS: Radiographic evaluation and clinical outcomes were assessed preoperative, immediate postoperative, 4 weeks after surgery and the final follow-up. RESULTS: In radiographic evaluation, fusion rate was 95% of each group. The difference was not significant that fusion time in H group versus S group was 6.9 months versus 7.4 months. At the preoperative, immediate postoperative, 4 weeks after surgery and the final follow-up, lordosis of fusion level was 8.8, 13.5, 13.5, 10.6 degrees in the H group, otherwise, 11.2, 13.4, 12.1, 10.3 degrees in the S group. Thus, S group had a tendency to be more decreased of lordosis than H group at 4 weeks after surgery, but the difference was not significant of each group at the final follow-up. There was no statistical difference about JOA score and VAS between the two groups. The difference was not significant that period of external support wearing in H group versus S group was 3.9 months versus 3.7 months. Two cases (5.4%) in S group were changed of rigid lumbar orthosis due to be migrated the screw for severe osteoporosis at 2 weeks after surgery. CONCLUSIONS: Postoperative external supports are commonly used in spinal fusion surgery to restrict trunk motion, to increase intra-abdominal pressure, and consequently to relieve lumbar trunk muscle and spine loads. Although PLIF using interbody cages and pedicle screw fixation provides ideal postoperative stability thought three-point fixation theory, evidences were not found to determine which type of postoperative external support is required for successful radiographic and clinical outcomes. The current study investigated the effect of postoperative external support in radiographic and clinical outcomes in a single-level PLIF. The results suggested that wearing the molded plastic TLSO should be no longer necessary in a single-level PLIF. DISCLOSURES: Device or drug: Steffee VSP system. Status: Approved for this indication. Device or drug: Brantigan I/F cage. Status: Approved for this indication. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.191 P28. Minimal invasive transforaminal lumbar interbody fusion (TLIF) successful clinical and radiographic outcomes at two year follow up James Schwender, MD1, Kevin Foley, MD2, David Rouben, MD3, Langston Holly, MD4; 1Minneapolis, MN, USA; 2Image-Guided Surgery Research Center, Memphis, TN, USA; 3River City Orthopaedic Surgeons, Louisville, KY, USA; 4University of California, Los Angeles, Los Angeles, CA, USA BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) continues to gain popularity as a treatment of choice for lumbar spine fusion. This treatment avoids the need for anterior exposure of the lumbar spine to obtain circumferential fusion while providing direct decompression of the neural elements. PURPOSE: To evaluate a novel, minimally invasive approach to the unilateral TLIF procedure and report 2-year results. STUDY DESIGN/SETTING: This is a prospective, multicenter, study of consecutive surgical patients treated with the same surgical intervention. The METRx cannula system (Medtronic Sofamor Danek) is used unilaterally through a 22 or 26mm tubular retractor to allow for unilateral facetectomy followed by subtotal discectomy. Structural interbody support is