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 - PowerPoint PPT Presentation

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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

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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


1
Improved 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

2
Results 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
3
Materials and Methods
National Spine Register 1993 start 1998
patient-based protocol 2003 web-based register
49,614 patients registered
4
Materials and Methods
1310 patients with DDD
UIF uninstrumented posterolateral 115 patients
IPF instrumented posterolateral 620 patients
IBF posterior interbody fusion 575 patients
5
Baseline data
Groups were adjusted for age, sex, smoking,
baseline regular use of analgesics
6
Results - ODI
No significant differences
7
Results - EQ-5D
No significant differences
8
Results - VAS leg
No significant differences
9
Results - VAS back
Significantly (8/100 points) lower VAS back for
IBF compared to UIF (plt0.01).
10
Discussion
  • 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
11
Discussion
  • 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
12
Conclusion
  • 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.
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