Patient Outcome in Posterior Lumbar Interbody Fusion PLIF Surgery A review of 182 cases performed by

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Patient Outcome in Posterior Lumbar Interbody
Fusion (PLIF) SurgeryA review of 182 cases
performed by Mr KrishnaPresented by Dr Raymond
PollockResearch Co-ordinatorSpinal Unit
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The PLIF Procedure _at_ NTH

• Study period March 1997 to November 2003
• 229 patients underwent PLIF
• 182 patients have both baseline follow-up (80
  response)
• Outcomes measured at baseline (pre-op) and at a
  single follow-up (post-op)
• Median follow-up 15 months (range 349 months)

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PLIF Data Set Variables Recorded

• Demographic variables
• Complications
• Operative time
• Blood loss
• Days of hospitalisation
• Variables assessing outcome (next slide)

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Outcome Measures

• Oswestry disability index (ODI)
• Measures effect of back/leg pain on activities of
  daily living
• Visual Analog Scales (VAS) for back and leg pain
• SF-36 generic health questionnaire
• Measures 8 dimensions of health

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Outcome Assessment cont

• Other assessments
• Pain drawing
• Psychological assessments
• Zung
• MSPQ
• Work related details
• Satisfaction with surgery medical care
• Medication usage
• analgesics
• alcohol

DRAM
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Statistical Analysis

• Data analysed using SPSS/SAS
• Data checked for normality before using
  parametric methods
• Significance designated at P lt 0.05
• All tests were 2 tailed
• Where data is skewed -median is reported

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Demography etc

• 182 patients
• 99 females
• 83 males
• Mean age at PLIF 45.3 years
• Age range 15 67 years
• 110 one level fusion
• 72 two level fusion

• Most common level L5/S1

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• Range 3 months 40 years
• Median 63 months

Duration of Pre-operative Pain
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PATIENT OUTCOMES
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Oswestry Disability Index (ODI)

• LBP specific
• Self administered
• Widely used
• Effect of pain on ADL
• 9 sections
• eg lifting/walking/travelling
• 6 statements
• Final score 0 (good) 100 (bad)
• lt20 minimal disability, gt80 severely disabled
• Population norm 10
• 10 -15 points drop clinically significant
  improvement

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Our Results ODI
t-test P 0.001 95 CI for difference (23.8)
18.4 29.2 45 improvement
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Visual Analogue Scale (VAS)

• Measures severity of leg/back pain

• 2 4 drop clinically significant improvement

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Our Results VAS scores
t-test leg pain P 0.001 95 CI for difference
(3.3) 2.0 4.3 50 improvement
t-test back pain P 0.001 95 CI for difference
(3.9) 3.2 4.8 51 improvement
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SF-36

• Generic instrument
• Self administered
• Widely used
• 36 questions over 11 sections
• Measures 8 dimensions of health
• PF/RP/BP/GH/VT/SF/RE/MH
• PF, RP, BP most responsive dimensions in LBP
• 0 100 higher scores better
• Norms for different populations
• No consensus on clinically significant
  improvement

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Our Results SF-36 Scores
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SF-36 Scores
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Summary

• ODI
• 45 improvement
• VAS Back
• 51 improvement
• VAS Leg
• 50 improvement
• SF-36
• 12-69 improvement

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Conclusion

• PLIF surgery reduces pain, improves
  functioning and quality of life in patients with
  chronic low back leg pain unresolved by
  conservative therapy

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Any Questions ?