Document Detail


Fusion rates and SF-36 outcomes after multilevel laminectomy and noninstrumented lumbar fusions in a predominantly geriatric population.
MedLine Citation:
PMID:  18458584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: This study prospectively analyzed posterolateral fusion rates and Short-Form 36 (SF-36) outcomes after multilevel lumbar laminectomies and noninstrumented fusions. OBJECTIVE: SF-36 outcomes and posterolateral fusion rates were assessed. SUMMARY OF BACKGROUND DATA: Technologically advanced and expensive instrumentation techniques and fusion adjuncts (ie, bone morphogenetic protein) may not be necessary to achieve lumbar fusion in the geriatric population. Rather, noninstrumented fusions using lamina autograft and a bone volume expander may suffice. METHODS: Seventy-five patients averaging 69 years of age (49 females, 26 males) underwent average 4.9 level lumbar laminectomies with average 2.0 level noninstrumented posterolateral fusions using lamina autograft (average 30 cm) supplemented with demineralized bone matrix (average 30 cm) in a 50:50 mix. Two independent radiologists separately evaluated both 2-dimensional computed tomography (2D-CT) and dynamic x-ray data 3, 4.5, 6, and up to 12 months postoperatively; patients had to demonstrate fusion on both studies. Outcomes were assessed using the SF-36 questionnaire (preoperatively) 3, 6, 12, and 24 months postoperatively. Patients were followed an average of 3.3 years (minimum 2 y). RESULTS: Thirteen (17.3%) patients demonstrated pseudarthrosis as they had not fused on dynamic x-ray and/or 2D-CT studies an average of 5.6 months postoperatively. One patient required a secondary fusion. One and 2 years postoperatively, patients demonstrated nearly identical maximal improvement on 6 SF-36 Health Scales, but showed no real changes on General Health and Mental Health scales. CONCLUSIONS: Seventy-five predominantly geriatric patients underwent multilevel laminectomies with noninstrumented fusions using lamina autograft combined with a bone volume expander. Thirteen patients (17.3%) demonstrated pseudarthrosis on the basis of both dynamic x-ray and 2D-CT criteria; 1 patient required a second instrumented fusion. Moderate pseudarthrosis rates, a low reoperation rate, and satisfactory SF-36 outcomes were achieved using noninstrumented posterolateral fusions in a predominantly geriatric population.
Authors:
Nancy E Epstein
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  21     ISSN:  1536-0652     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-09     Completed Date:  2008-07-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-64     Citation Subset:  IM    
Affiliation:
The Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bone Matrix / transplantation*
Female
Humans
Laminectomy / instrumentation,  methods*
Lumbar Vertebrae / radiography,  surgery*
Male
Middle Aged
Prospective Studies
Questionnaires
Spinal Diseases / radiography,  surgery*
Tomography, X-Ray Computed
Transplantation, Autologous
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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