Introduction: The efficacy of lumbar fusion for degenerative disc disease (DDD)
without stenosis remains unclear and highly debated by
physicians, payers, and policy makers. Many patients with
medically refractory mechanical axial back pain and significant
lumbar disc height collapse are denied access to fusion
procedures by their respective payer policies. Utilizing a
standardized definition for DDD, we set out to determine if lumbar
fusion was associated with improved patient-reported health
benefits in a prospective nationwide registry.
Methods: Quality Outcomes Database (QOD) registry collects one-year patient-reportedoutcomes(PROs) after surgical care for six lumbar diagnosis
groups. We queried all surgical cases that were enrolled under the
DDD diagnosis group “symptomatic mechanical disc collapse”
defined a priori as reproducible mechanical axial back pain with
>50% disc height loss without stenosis or listhesis proven to be
medically refractory >3months. The relative prevalence, safety,
and effectiveness of surgery for symptomatic mechanical disc
collapse was assessed.
Results: 7618 patients from 74 hospitals in 26 U.S. states were enrolled
and completed 12month PROs. Symptomatic mechanical disc
collapse represented the minority of these surgical cases at
N2QOD hospitals [42(0.6%)],Table 1. All cases underwent singlelevel
fusion and associated with mean EBL(327cc), length of
stay(3.5days), discharge to inpatient rehab(12%), 30-day
morbidity(9%) and 90-day all-cause readmission(9%),Table 2.
Lumbar fusion resulted in 12month improvement in back pain(BPNRS:
8 vs 5.3,p<0.001); leg pain(LP-NRS:6.5 vs 4.3,p<0.001);
disability(ODI:54 vs 42,p<0.001); and quality of life(EQ5D:0.49 vs
0.59,p<0.005. Postoperative return to work reached 66%
at 3mo and 100% by 12month.
Conclusions: Lumbar fusion for symptomatic mechanical disc collapse without
stenosis or listhesis represented the minority of surgical practice at
the 74 N2QOD centers between 2010 and 2015. Those patients
undergoing lumbar fusion for this narrowed definition of DDD
experienced improvements in all measured domains of health,
suggesting lumbar fusion is an effective treatment for back pain
arising from mechanical disc collapse.
Patient Care: The patients undergoing lumbar fusion for symptomatic
mechanical disk collapse without stenosis or listhesis experienced
improvements in all measured domains of health, suggesting
lumbar fusion is an effective treatment for back pain arising from
mechanical disk collapse
Learning Objectives: DDD patients undergoing fusion surgery have come under great
scrutiny by physicians, patients, insurance companies, and policy
makers, with the recent publications in a high impact journal by 2
independent groups coming to opposing conclusions. In this study,
we attempted to answer the elusive question, “Does the lumbar
spinal fusion improve pain, disability, and quality of life in patients
with chronic discogenic back pain?” The conclusion from this study
indicates that fusion improves back and leg pain, lowers disability,
increases quality of life, and enables patients to go back to work.