Patient outcomes after lumbar spinal fusions

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Lumbar spinal fusion is a common surgical procedure for various low back disorders.
• The efficacy and complication rates of spinal fusion require thorough evaluation.

Purpose of the Study:

• To assess the success and complication rates of lumbar spinal fusion.
• To identify predictors of favorable outcomes after fusion.
• To determine if fusion enhances laminectomy success for specific low back conditions.

Main Methods:

• Systematic review of English-language articles from 1966 to April 1991.
• MEDLINE searches, bibliography review, and expert consultations identified relevant studies.
• Inclusion criteria required at least 1 year of follow-up and data on at least 30 patients.

Main Results:

• No randomized controlled trials were identified; four nonrandomized studies found no fusion advantage for herniated disks.
• Average satisfactory outcome rate after fusion was 68% (range: 16%-95%), lower in prospective studies.
• Common complications included pseudarthrosis (14%) and donor site pain (9%); outcomes worsened with prior surgeries.

Conclusions:

• Spinal fusion offers no demonstrated advantage over non-fusion surgery for several low back disorders.
• Complications associated with spinal fusion are frequent.
• Rigorous randomized controlled trials are necessary to compare fusion, non-fusion surgery, and conservative treatments.