Limited quality of life improvements seen after lumbar fusion for revision

Djurasovic M. Spine. 2011;36:269-276. doi:10.1097/BRS.0b013e3181cf1091.

Patients undergoing lumbar spinal fusion as a revision procedure can anticipate only small improvements in health-related quality of life, according to this retrospective cohort analysis.

Mladen Djurasovic, MD, of Norton Leatherman Center in Louisville, Ky, and colleagues used a single-center database to identify 171 patients who underwent lumbar fusion to revise a lumbar spine surgery. All patients had prospectively collected outcome measures at a minimum of 2-years’ follow-up. In this study, 91 patients had previous discectomy of laminectomy, 42 patients were undergoing revision for adjacent segment degeneration, and 38 patients were undergoing revision for nonunion.

Patients completed the Oswestry Disability Index (ODI), SF-36 and back and leg pain numerical rating scores before surgery, and at 1- and 2-years postoperatively.

All three groups had statistically significant improvements in back pain, leg pain and the ODI. Patients with postdecompression and adjacent segment degeneration had significant improvements in SF-36 physical component scores (PCS) at 2 years, while nonunion patients did not. Forty-nine percent of postdecompression patients, 38% of adjacent segment degeneration patients and 29% of nonunion patients reached the minimum clinically improvement difference (MCID) threshold for SF-36 PCS. The only factor that predicted reaching the MCID for ODI was significant improvement from index surgery. Worker’s compensation status and narcotic use predicted failure to reach the MCID for SF-36 PCS.

These results indicate that additional research is needed to determine which preoperative predictors will help identify patients who will benefit from revision lumbar fusion, the authors wrote.