Patient Outcomes After Lumbar Spinal Fusions

TLDR

The study aims to assess success and complication rates of lumbar spinal fusion, identify predictors of good outcomes, and evaluate whether fusion improves laminectomy success for specific low back disorders. The authors conducted a systematic review of 47 English-language studies from 1966–1991, extracting data on patient characteristics, surgical methods, outcomes, and study quality, with only studies reporting ≥1 year follow‑up and ≥30 patients included. Across the reviewed studies, lumbar fusion yielded a 68 % satisfactory outcome rate (range 16–95 %) but offered no advantage over non‑fusion surgery for herniated disks or other low back disorders, with common complications such as pseudarthrosis (14 %) and donor‑site chronic pain (9 %).

Abstract

To determine success and complication rates for lumbar spinal fusion surgery, predictors of good outcomes, and whether fusion improves success rates of laminectomy for specific low back disorders.English-language journal articles published from 1966 through April 1991, identified through MEDLINE searching (spinal fusion plus limiting terms), bibliography review, and expert consultation.Articles were selected only if they reported at least 1 year of follow-up data enabling the classification of clinical outcomes as satisfactory or unsatisfactory for at least 30 patients.Two reviewers independently extracted data on patient characteristics, surgical methods, patient outcomes, and quality of study methods.Of 47 articles, there were no randomized trials. Four nonrandomized studies compared surgery with and without fusion for herniated disks; three found no advantage for fusion. On average, 68% of patients had a satisfactory outcome after fusion, but the range was wide (16% to 95%), and the satisfactory outcome rate was lower in prospective than in retrospective studies. The most frequently reported complications were pseudarthrosis (14%) and chronic pain at the bone graft donor site (9%). Clinical outcomes did not differ by diagnosis or fusion technique, but were worse in studies with a greater number of previously operated patients.For several low back disorders no advantage has been demonstrated for fusion over surgery without fusion, and complications of fusions are common. Randomized controlled trials are needed to compare fusion, surgery without fusion, and nonsurgical treatments in rigorously defined patient groups.