Presentation @ the Congress of Neurological Surgeons 2011 Annual Meeting, Oct 2011
INTRODUCTION
Lumbar fusion rates have steadily increased since the 1990’s. However, after lumbar fusion approximately 40% of patients remain unchanged or become even worse as measured by Oswestry at two year follow-up. Our analysis group represents those patients treated here who had fusion recommended, by outside surgeons, but the patients chose our smaller access out-patient discectomy instead. This procedure is a focused, precision discectomy. Our retrospective analysis goal was to determine whether these patients had undergone a later fusion. Our success is defined as those patients that have avoided fusion (90%).
METHODS
59 patients were available for follow-up. 35 % were women (n=21) and 65 % men (n=38) with an average age of 42 years old, ranging from 21 to 70 years of age. 16% of patients presented with primarily low back pain and 77% had objective signs of radiculitis. The average follow-up was 43 months.
RESULTS
There were 9 patients who underwent a reoperation: 6 fusions, 1 disc decompression, 1 laminectomy/foraminotomy and 1 minimally invasive discectomy. Therefore, our success rate for avoiding fusion was 90 % and for avoiding any further procedure was 85%. Of the 6 patients that required fusion: 1 had 2 previous lumbar operations, 1 had concomitant multiple sclerosis, 1 had a previous fusion one segment below and one had spondylolysthesis. All but 1 re-operated case presented with hard disks. 70 % of patients showed excellent and good clinical results. No complications were reported.
CONCLUSIONS
Fusion should only be done after a careful evaluation of the individual case taking into consideration all factors involved, including whether much smaller procedures may be sufficient. The use of the smaller access discectomy technique was shown above to be a valuable tool in avoiding fusion of the lumbar spine, even in cases where associated factors beyond the discopathy were not surgically treated.