No difference in clinical outcome after posterolateral lumbar fusion between patients with isthmic spondylolisthesis and those with degenerative disc disease using pedicle screw instrumentation: a comparative study of 112 patients with 4 years of follow-up.

We compared the clinical outcome after spinal fusion between patients with isthmic spondylolisthesis and those with degenerative disc disease of the lumbar spine, using multiple logistic regression analysis. A questionnaire describing medication, pain, vocational status and patient satisfaction was mailed to all the patients at a median interval of 4 years after their operation. Fusion was evaluated on plain radiographs at a minimum of 12 months after surgery, and patients were classified as fused or not fused. The overall satisfaction rate was 70%. The results of the present study showed no difference in the outcome after spinal fusion between the two groups of patients. The factors that significantly increased the likelihood of an optimal result - defined as patient satisfaction, return to work, and reduced medication - were male gender, being in work prior to surgery, and being a non-smoker. Since spinal fusion is an expensive treatment with potentially serious risks, and leaves one-third of the patients with an unsatisfactory result, we believe that more studies focusing on the indications for surgery should be performed.

[Hip joint operations in routine patient management--determinants of quality of life]. / Hüftgelenkoperationen in der Routineversorgung--Determinanten der Lebensqualität.

The study was conducted in co-operation with a German sickness fund to identify determinants of health related quality of life (HRQL) after hip surgery in routine health care. In 9/97 all beneficiaries (age 40-75 years), which were treated in hospital for osteoarthrosis (n = 1352), were sent a questionnaire on average 5.2 months (t1), postoperatively. The standardized questionnaire contained a.o. items about pre- and postoperative subjective assessment of disease specific symptoms (Lequesne-Index), complications, comorbidity, health related quality of life (SF-36). The response rate at t1 was 67.8%. Patients with hip surgery (n = 390) were sent a second questionnaire 17.2 months (t2) postoperatively. At t2 data from 293 patients were available for analysis. Patients (57.6% male) were on average 61 years of age and 61.2% reported no co-morbidity. 88.4% received total hip replacement. 30.3% of patients reported at least one complication. HRQL in patients after hip surgery is significantly impaired in six of the eight SF-36 subscales compared to the German norms at t1 and t2. From t1 to t2 substantial improvements appear in the SF-36 subscales physical functioning, role physical and bodily pain (p < 0.001). Major determinants of HRQL are comorbidity (if yes: less improvement) and attendance of inpatient rehabilitation (if yes: more improvement). In routine healthcare HRQL after hip surgery is determined by patient characteristics and postoperative rehabilitation. Inspite of substantial improvements patients did not (yet) reach the level of the reference population.