[Surgical treatment of degenerative lumbar diseases]

The diagnosis and treatment of painful degenerative spinal diseases remains controversial in the literature, and surgical treatment differs greatly between centres and surgeons. We have evaluated our results over a nine-year period.

237 patients referred with chronic degenerative spinal diseases could be evaluated, 132 women and 105 men, median age 48 (17 - 85). Median symptom duration was 10 years (1.5 - 50 years). The patient files were retrospectively studied independently by two surgeons. Out of the patients, 83 (35 %) had previously had lumbar spine operations, mainly discectomies. All patients were controlled as outpatients with clinical examination and an X-ray taken of the lower spine columna at least once. The final evaluation of patient satisfaction with the operation, pain and walking and working capacity was based on a questionnaire.

Out of these patients, 64 were treated with decompression only, 173 had additional posterolateral fusion with bone or instrument. Fusion rate was 90 %, with no significant difference between type of fusion (p = 0.07). After a median observation time of 5.2 years (0.5 - 10.5 years) 75 % of the patients were very satisfied or satisfied with the outcome; 48 % were back at work. Factors significantly related to poor results were little preoperative pain (p < 0.001), previous back operations (p = 0.003) and long preoperative sick leave (p = 0.015).

Our results are comparable with most published studies. One should be restrictive with surgery on patients with little pain, long sick leave, preoperative inactivity, and previous multiple spinal operations.