J Korean Soc Spine Surg.  2003 Dec;10(4):290-296.

Results of Multilevel Lumbar Fusion for Degenerative Disorder of the Lumbar Spine

• Lee CS
• Chung SS
• Chung KH
• Kim ES
• Kim HK

Abstract

PURPOSE
To investigate the causative factors of the complications and clinical results of 82 patients that underwent multilevel fusion due to degenerative lumbar disease.
MATERIALS AND METHODS
This was a retrospective study, between October 1994 and July 2001, of 101 patients that had undergone spinal fusion at more than 3 levels, due to degenerative lumbar disease, and excluding 19 patients, which included 8 revisions, 1 postop infection and 10 lost to follow-up. The average age of the 82 patients was 61, ranging from 49 to 81 years. There were 22 men and 60 women, with an average follow up of 35, ranging from 12 to 79 months. Inclusion in the study required a minimum of 1 year of radiographic follow-up, where the lumbar lordotic angle, lateral sagittal angle of the fusion segments, problems associated with instrumentation (screw loosening, breakage and rod breakage), nonunion, fusion level, extension to sacrum, medical comorbidities and their influences on the clinical results were evaluated. Evaluation of the clinical results were quantified using Kirkaldy-Willis'criteria. T-test, Chi-square test and Pearson correlation tests were performed to evaluate the statistical significance, using SPSS version 10.0.
RESULTS
12, 35, 20 and 15 of the 82 patients declared their outcomes to be excellent, good, fair and poor, respectively. The clinical results were statistically associated with the difference between the postoperative and final sagittal angle in the fusion segments (p<0.05). The more fusion segments involved, the more problems associated with the instrumentation occurred. The number of fusion levels affected the clinical results.
CONCLUSION
It seems to be difficult to reach satisfactory results in the case of multilevel spinal fusion, which was mostly associated with problems of instrumentation and nonunion, which showed poorer clinical results. Maintenance of the sagittal angle in the fusion segments was challenging when the number of fusion levels was increased.

Keyword

Multilevel fusion; Degenerative spinal disease

MeSH Terms

Comorbidity
Female
Follow-Up Studies
Humans
Lost to Follow-Up
Male
Retrospective Studies
Sacrum
Spinal Fusion
Spine*

Reference

1). Cleveland M, Bosworth DM, Thompson FR. Pseudoarthrosis in the lumbosacral spine. J Bone Joint Surg. 1948; 30(2):302–312.

2). Lehmann TR, La Rocca HS. Repeat lumbar surgery. A review of patients with failure from previous lumbar surgery treated by spinal canal exploration and lumbar spinal fusion. Spine. 1981; 6:615–519.

3). Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, lffig TM, Lenke LG. Minimum 2-Years Analysis of Sacropelvic Fixation and L5-S1 Fusion Using S1 and Iilac Screws, Spine. 2001; 26:1976–1983.

4). Pihlajamaki H, Myllynen P, Bostman O. Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg. 1997; 79(Br):183–9.

5). Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, Deyo R. Patient outcomes after lumbar spinal fusion. JAMA. 1992; 268:907–911.

6). Stroll JE, Oldridge NB, Juan Z, Rimm AA. S urg er y benifits lifespan, Orthopedics Today. 1993; 2:22–3.

7). Doherty JH. complication of fusion in lumbar scoliosis. J Bone Joint Surg. 1973; 55-A:438.

8). DePalma AF, Rothman RH. The nature of pseudoarthrosis. Clin Orthop. 1968; 59:113–8.

9). Steinmann JC, Herkowitz HN. Pseudoarthrosis of the spine. Clin Orthop. 1992; 284:80–90.

10). Aebi M, Etter C, Kehl T, Thalgott J. The internal skeletal fixation system: a new treatment of thoracolumbar fractures and other spinal disorder, Clin Orthop. 1988; 227:30–43.

11). Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery, Clin Orthop. 1988; 227:10–23.

12). Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH. Lumbar laminectomy alone or with instrumented or noninstru -mented arthrodesis in degenerative lumbar spinal steno -sis: Patient selection, costs and surgical outcomes, Spine. 1997; 22:1123–1131.

13). O’ Beirne J, O’ Neil D, Gallagher J, Williams DH. Spinal fusion for back pain: a clinical and radiological review, J Spinal Disord. 1992; 5:32–8.

14). Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusion. Spine. 1993; 18:1186–9.

15). Kant AP, Daum WJ, Dean M, Uchida T. Evaluation of lumbar spine fusion: plain radiographs versus direct surgical exploration and observation. Spine. 1995; 21:2313–7.

16). Kim SS, Michelson CB. Revision surgery for failed back surgery syndrome. Spine. 1992; 17:957–60.

17). Stauffer RN, Coventry MB. Posterolateral lumbar spine fusion. Analysis of the Mayo clinic seriesatic disorders. J Bone Joint Surg. 1972; 54(6):1195–1204.

18). Conley FK, Cady CT, Lieberson RE. Decompression of lumbar spinal stenosis and stabilization with Knodt Rods in the elderly patient. Neurosurgery. 1990; 26:758–63.

19). Greenfield RT, Capen DA and Thomas JC et at. Pedicle screw fixation for arthrodesis of the lumboscral spine in the elderly. Spine. 1998; 23:1470–5.