Outcome of spinal fusion for lumbar degenerative disease: a cross-sectional study in Korea.

STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: To evaluate the degree of postoperative pain and patients' satisfaction after lumbar fusion from a nationwide survey in Korea. SUMMARY OF BACKGROUND DATA: There have been few studies that investigated the factors related to patients' satisfaction after spinal fusion in lumbar degenerative disease (LDD). METHODS: This study included 629 patients who underwent spinal fusion for LDD at clinics of designated members of the Korean Society of Spine Surgery. This survey was done in 123 hospitals with 171 spine surgeons. Questionnaires for patients included severity of present back pain and radicular pain (visual analog scale score), Oswestry Disability Index (ODI), and subjective outcomes. Questionnaire for surgeons included preoperative diagnosis, level of fusion, operative method, and presumed patient's pain. RESULTS: The patients were 199 men and 430 women, with mean age of 62.3 years. The mean visual analog scale score of back pain and radicular pain was 5.0 +/- 2.6 and 4.4 +/- 3.0, respectively. The mean ODI was 44.3 +/- 19.4. ODI was significantly increased with older age, workers' compensation, and increased fusion extent. Correlated factors of dissatisfaction were severe back pain, higher ODI, multiple operation, and insufficient explanation about postoperative pain. There was a significant correlation between preoperative explanation about postoperative pain and degree of patient's pain. CONCLUSION: Patients' satisfaction was not as high as expected after fusion for LDD. Therefore, the decision for performing a lumbar fusion in those patients must be done more carefully, and it should be explained more precisely that chronic pain may persist after spinal surgery.

Fusion rates and subsidence of morselized local bone grafted in titanium cages in posterior lumbar interbody fusion using quantitative three-dimensional computed tomography scans.

STUDY DESIGN: Prospective, controlled study. OBJECTIVE: To determine fusion rates, cage to bone contact area ratios, and subsidences using titanium cages filled with a local bone graft for posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND DATA: PLIF using decompressed local bone inserted in titanium cages combined with pedicle screw fixation is a popular procedure for treating lumbar spine degeneration. There is no report about cage to bone contact area ratios using titanium cages filled with a local bone graft for PLIF. METHODS: PLIF using a titanium cage filled with excised laminar and facet joint bone with pedicle screw fixation was performed in 54 (78 levels) consecutive patients. Mean age at the time of surgery was 62.5 years. Radiographic assessments of posterior and anterior disc heights were performed. Three-dimensional thin-section computed tomography assessments of cage subsidences, fused area ratios of local bone inside cages, and overall fusion rates were analyzed. RESULTS: Mean values of anterior and posterior disc heights at 1 year after surgery were significantly greater than mean preoperative disc heights. The fusion rate of cages over both upper and lower segment endplates was 96.2%. The ratios of fused areas of local bone inside cages exposed to upper and lower segment endplates were 46.7% and 52.2% in the coronal plane and 46.4% and 49.9% in the sagittal 3-dimensional computed tomography plane, respectively. And, subsidences of titanium cages at upper and lower segment endplates were 1.26 mm and 0.72 mm in the coronal plane and 1.04 mm and 0.53 mm in the sagittal plane, respectively. CONCLUSION: The ratio of fused area of local bone inside cages at regions exposed to endplates was <50%, which is insufficient for physiologic load transmission. The authors recommend that additional bone should be grafted into the disc space or new bone bonding interbody spacer should be considered.

A case of postoperative tuberculous spondylitis with a bizarre course.

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.