Single-level lumbar fusion in chronic discogenic low-back pain: psychological and emotional status as a predictor of outcome measured using the 36-item Short Form.

OBJECT: The authors examined the effect of psychological and emotional status on the outcome in patients with suspected chronic discogenic low-back pain (LBP) who have undergone lumbar fusion. METHODS: The authors retrospectively analyzed the medical records, including the results of the 36-item Short Form (SF-36), of 57 consecutive patients (mean age 42.7 years) who underwent single-level lumbar reconstructive surgery between 1994 and 2000. The SF-36 physical component summary (PCS) and mental component summary (MCS) domains were evaluated. Data were sorted into the following categories: excellent, good, fair, same, and worse. Scores greater than 40 for MCS and PCS were defined as "normal" according to US general population data provided by the Medical Outcomes Trust. Of 57 patients, 47 completed postoperative SF-36 surveys at 1 year and 36 completed the 2-year follow-up surveys. Analysis showed that preoperative MCS scores exhibited a significant, direct correlation with PCS score improvements at 1 (r = 0.584, p = 0.000) and 2 (r = 0.623, p = 0.000) years after surgery. In patients in whom preoperative MCS scores reflected normal status, outcomes were excellent or good in 60% at 1-year (18 of 30 cases) and 2-year (15 of 25 cases) follow-up intervals. Patients in whom MCS scores represented abnormal status had less satisfactory outcomes, with excellent or good outcome in only two (18.2%) of all patients at the 2-year follow-up study. CONCLUSIONS: Analysis of the data suggests that psychological and emotional distress may negatively affect postoperative outcome in patients with chronic discogenic LBP. The SF-36 may be easily and effectively used to measure both preoperative psychosocial distress and postoperative outcome.

Does the number of levels affect lumbar fusion outcome?

STUDY DESIGN: Retrospective outcome measurement after circumferential reconstructive surgery with lumbar fusion in patients with chronic discogenic low back pain. OBJECTIVE: To examine the effect of the number of fusion levels on surgical outcomes in patients with chronic discogenic low back pain using provocative pressure-controlled diskography as a primary diagnostic tool. SUMMARY OF BACKGROUND DATA: Although there is general agreement that construct length adversely affects arthrodesis success rates, the effect of the number of levels on lumbar fusion surgery outcome has not been reported. Previous fusion outcome studies have generally relied on magnetic resonance imaging or conventional diskography for diagnosis. METHODS: From 1994 through 2000, prospectively collected medical records of patients who underwent reconstructive lumbar spine surgery with confirmation of the pain generator by pressure-controlled diskography were retrospectively analyzed. Data were subdivided into 2 groups of patients. The first group, designated the short segment group, contained patients who underwent fusion at 1 or 2 levels. The second group, designated the long segment group, contained patients who underwent fusion at 3-5 levels. Surgical methods included circumferential reconstruction of the lumbar spine by either posterior or combined anterior and posterior approach. Surgeries included posterior decompression necessary to relieve documented regions of neural compression, combined with interbody arthrodesis at selective levels, augmented by posterior segmental spinal instrumentation and posterolateral arthrodesis. All patients completed a preoperative aquatic-conditioning program. Whenever possible, coexisting medical conditions were corrected or stabilized before surgery. A preoperative Short Form RAND 36-Item Health Survey (SF-36) was completed, and repeated at 1 and 2 years after surgery. The short and long segment groups contained 142 and 82 patients, respectively, who completed the preoperative SF-36 questionnaire completely. RESULTS: One hundred patients in the short segment group (vide infra) were available for 1-year follow-up, and68 were available for 2-year follow-up. In the long segment group, 81 patients were available for 1-year follow-up, and 49 were available for 2-year follow-up. Mean ages were 41.0 and 47.6 years in the short and the long segment groups, respectively. The 2 groups did not differ significantly in gender, smoking habits, workers' compensation, or litigation (P > 0.05). In the short segment group, postoperative 1-year mean Physical Component Summary (PCS) and Mental Component Summary scores significantly improved (P < 0.001 and P = 0.002, respectively). Domains other than general health perceptions showed significantly improved 1-year follow-up scores (P 0.05), although the PF score showed differences in 1 and 2-year follow-up scores (P = 0.048 and P = 0.068, respectively). CONCLUSIONS: When using strict patient selection criteria that include independent determination of pain generators via pressure-controlled diskography and completion of a preoperative conditioning program for improving general health status, the number of levels in reconstructive lumbar surgery may not significantly impact overall clinical outcome.