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Study finds no difference in lumbar pseudarthrosis treatment based on surgical approach

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LAS VEGAS — Results of a retrospective study presented at the American Academy of Orthopaedic Surgeons Annual Meeting, here, showed that regardless of the surgical approach used, patients with pseudarthrosis after lumbar spine surgery who were re-operated attained 17% to 28% minimally clinically important differences measured by the Oswestry Disability Index.

The study presented by Roger K. Owens II, MD, highlighted the severity of developing pseudarthrosis after lumbar spine fusion surgery and its effect on patients’ health-related quality of life.

“Failure rates in the literature range anywhere from 40% to 70% repeat fusion for pseudarthrosis,” Owens said.

Owens and his colleagues studied 134 patients with 2-year follow-up who were treated for symptomatic pseudarthrosis with surgery performed with a range of approaches, such as transforaminal lumbar interbody fusion, posterolateral fusion and anterior interbody fusion. The findings showed the groups of patients treated with each approach were similar.

The outcome measures the investigators studied were the average Oswestry Disability Index, the SF-36 and the Numeric Rating Scale for back and leg pain. Although none of the outcome measures were statistically significantly different based on surgical approach, Owens said he and his colleagues identified posterior spinal fusion as the approach associated with the greatest improvement in all the studied outcome measures.

Based on minimally clinically important differences (MCID), “we found that the anterior-posterior groups saw the largest percentage of patients reaching MCID in all the outcome domains except for the SF-36 [physical component score] PCS,” Owens said.

A linear regression analysis also showed surgical approach used was not predictive of a change in outcomes. “I think that this emphasized the importance of achieving a solid fusion with the index surgery,” Owens said. – by Susan M. Rapp

Reference:

Owens RK, et al. Paper #464. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.

Disclosure: Owens reports no relevant financial disclosures.