Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Backbone Really Improved Outcomes?
World Neurosurg. 2018 Apr 06;:
Authors: Prolo LM, Oklund SA, Zawadzki N, Desai M, Prolo DJ
BACKGROUND: Since 1980s quite a few operations have changed posterior lumbar interbody fusion (PLIF) with human bone. These usually contain costly implants and sophisticated procedures. Escalating expenditures in lumbar fusion surgical procedure warrant re-evaluation of classical PLIF with allogeneic ilium and with out instrumentation. The aim of this examine was to find out the long-term fusion price and scientific outcomes of allo-PLIF.
METHODS: Between 1981-2006 321 sufferers ages 12-80, underwent 339 one- or two-level allo-PLIFs for degenerative instability and have been adopted 1-28 years. Fusion standing was decided by radiographs and as accessible, by CT scans. Medical consequence was assessed by the Financial/Practical Consequence Scale.
RESULTS: 308 of the 321 sufferers have been adopted postoperatively (common 6.7 years, vary 1-28); 297 (96%) fused. Fusion charges have been decrease for sufferers with substance abuse (89%, p=zero.007). Medical outcomes in 87% of sufferers have been wonderful (52%) or good (35%). Financial/Practical Consequence Scale scores following preliminary allo-PLIF on common elevated 5.2 factors. Profitable fusion correlated with practically a 2-point acquire in consequence rating (p=zero.001). A constructive affiliation between a affected person attribute and consequence was noticed solely with age 65 and better; whereas unfavorable associations in scientific outcomes have been noticed with psychological sickness, substance abuse, heavy stress to low again, or industrial accidents. Complete complication price was 7%.
CONCLUSIONS: With three many years of follow-up we discovered profitable scientific outcomes are extremely correlated with stable fusion utilizing solely allogeneic iliac bone.
PMID: 29631080 [PubMed – as supplied by publisher]