Introduction: The purpose of this study is to assess the long-term outcomes of patients undergoing non-instrumented postero-lateral fusion of the lumbar spine.
Methods: We present 376 patients who underwent in situ, non-instrumented arthrodesis for lumbar degenerative disease over a 20-year period at a single institution. Patients were followed for an average of 83.2 ± 65.5 months after the index lumbar arthrodesis procedure.
Results: The average age for these patients was 61.1 ± 13.54 years, and 185 (49.2%) patients were male. Of the total 376 patients, 344 (91.5%) presented with back pain, 304 (95.9%) with radiculopathy, 20 (5.32%) with motor weakness, and 7 (1.86%) with pre-operative bowel/bladder dysfunction. An average of 1.76 ± 0.82 spinal levels were fused. Autograft was used in 345 (91.75%) patients, while allograft was utilized in 31 (8.24%) patients. Average blood loss was 625 ± 487 milliliters. 15 (3.99%) patients experienced intra-operative durotomy during the surgery. Peri-operatively, the average length of stay was 5.98 ± 5.78 days. Post-operatively, patients experienced a significant improvement in back pain (p<0.0001) and radiculopathy (p<0.0001). At last follow-up, 228 (60.64%) patients experienced continued or recurrent back pain, while 217 (57.71%) patients experienced continued or recurrent radiculopathy. The cumulative rate of adjacent segment disease development over time was 18.35%. The pseudoarthrosis rate was 5.59%. In total, the rate of reoperation due to non-improvement or worsening of symptoms was 30.59%.
Conclusions: We present one of the largest cohorts of patients undergoing in situ fusion for degenerative lumbar spine disease. We also present a cohort with one of the longest follow-up times, an average of over 7 years. We show that patients undergoing non-instrumented fusion have statistically significant improved back pain and radiculopathy post-operatively. Notably, while 18.35% of patient developed adjacent segment disease, 30.6% of patients required re-operation due to recurrent or worsening symptomsduring the follow-up period.
Patient Care: This research aims to further our understanding of in situ non-instrumented fusion. This procedure may be a viable alternative to instrumented fusion in select patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the surgical outcomes of non-instrumented fusion; 2) Identify the role of non-instrumented fusion in the treatment of spinal degenerative disease.
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