Title: Improved quality of life, pain, and function after spinal fusion in chronic low back pain are not dependent on operative technique 2-year-results of 1310 patients treated with posterolateral or posterior interbody fusion from the Swedish National Spine
1Improved quality of life, pain, and function
after spinal fusion in chronic low back pain are
not dependent on operative technique2-year-resul
ts of 1310 patients treated with posterolateral
or posterior interbody fusion from the Swedish
National Spine Register.
- Yohan Robinson, MD
- Karl Michaëlsson, MD, Prof
- Bengt Sandén, MD, PhD
- Uppsala University Hospital
- Institute for Surgical Sciences
- Department of Orthopaedics
2Results of fusion in CLBP/DDD
- No significant difference was found in the
global assessment of clinical outcome about
instrumented posterolateral fusion and
circumferential fusion
Gibson Waddell 2005 Han et al 2009
3Materials and Methods
National Spine Register 1993 start 1998
patient-based protocol 2003 web-based register
49,614 patients registered
4Materials and Methods
1310 patients with DDD
UIF uninstrumented posterolateral 115 patients
IPF instrumented posterolateral 620 patients
IBF posterior interbody fusion 575 patients
5Baseline data
Groups were adjusted for age, sex, smoking,
baseline regular use of analgesics
6Results - ODI
No significant differences
7Results - EQ-5D
No significant differences
8Results - VAS leg
No significant differences
9Results - VAS back
Significantly (8/100 points) lower VAS back for
IBF compared to UIF (plt0.01).
10Discussion
- Significant improvement with fusion surgery for
pain, function and QoL after 2 years - UIF inferior to IBF with regard to VAS back
- statistically significant but not clinically
relevant (Difference8, MCID14)
Årsrapport ryggregister 2009
11Discussion
- Primum nil nocere!
- Choice of method with least complications?
- Is 2-year follow-up enough?
- Results from Aarhus found differences which
appeared first after 5 9 years.
Videbaek et al, Spine 2006
12Conclusion
- This study could not give any evidence that there
is any method being superior to the other. - All groups improved in function, QoL, and pain
regardless of the chosen surgical method - We should wisely choose fusion methods that are
the least harmful and that we are technically
most confident with.