Prospective cohort analysis of disability reduction with lumbar spinal fusion surgery in community practice

Prospective cohort study of lumbar spinal fusion.

To examine the functional changes subsequent to lumbar spinal fusion in a total procedure audit in a community spinal surgery practice.

Several randomized controlled trials have demonstrated efficacy of spinal fusion procedures across diagnoses, but demonstrating effectiveness in community practice has been more difficult. Hospital database studies demonstrate incidence, reoperation rates, and complications of spinal fusions, yet cannot demonstrate outcomes consistently. The challenge is to demonstrate functional benefits from spinal fusion in a community setting.

Over a 5-year period all patients in a community practice who underwent lumbar spinal fusion procedures with additional pedicle screw stabilization for degenerative, spondylolytic and spondylolisthetic conditions, were evaluated with application of the Modified Rowland 23 point Questionnaire of Disability preoperatively, and at 1-year postoperative assessment. Statistical analysis was performed.

A median 10-point improvement in the Modified Roland Questionnaire score was achieved across 160 patients, and the improvement was highly statistically significant for the major diagnoses--degenerative spondylolisthesis, discogenic low back pain, and spondylolysis and isthmic spondylolisthesis. Greater reduction of disability was seen in primary procedures when compared with revision surgery, and in noncompensation patients when compared with compensation patients, although in neither case was the difference statistically significant.

This study has demonstrated that consistent functional improvements can be achieved across a total population of lumbar spinal fusions in a nonacademic setting. It also demonstrated that use of prospective cohort analysis techniques, with adequate follow up, and minimal increased costs to patients and practice, is a sustainable prospective audit technique.