Evidence of radiographic fusion linked with better clinical results vs nonunion

Data in this randomized trial showed the importance of achieving fusion for patients with degenerative disc disease who underwent single-level lumbar interbody arthrodesis, as patients who achieved radiographically confusion had better 12-month and 24-month follow-up results than patients who had nonunion.

Researchers included 496 patients who underwent single-level lumbar interbody arthrodesis and had clinical and radiographic data at 1-year and 2-year follow-up. The researchers used the results from four level 1 clinical trials for the current study.

In total, 428 patients achieved fusion after the procedures and 29 patients had radiographic nonunion, which did not require reoperation.

According to the researchers, patients who achieved fusion had better improvements in Numeric Rating Scale (NRS) back pain scores and Oswestry Disability Index (ODI) scores at 1-year and 2-year follow-up than those who did not achieve fusion.

After pooling the three clinical outcome scales, researchers found 77.8% of patients who achieved fusion exceeded the minimal clinically important difference (MCID) at 1-year and 2-year follow-up. About 54.8% of nonunion patients exceeded the MCID at 1-year and 2-year follow-up.

“Overall, the results of our pooled meta-analyses showed that patients with radiographically confirmed fusion had significantly better improvements in clinical outcomes at 1 [year] and 2 years postoperative than those of patients with radiographic nonunion. The overall percentage of fused patients with ODI and NRS back pain scores that exceeded the criteria for MCID was also significantly higher than that of patients with nonunion,” researchers wrote in the study. – by Robert Linnehan.

Disclosure: The researchers reported no relevant financial disclosures.

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Source:

Noshchenko A, et al. Spine. 2015;doi:10.1097/BRS.0000000000001113.