450 - A Systematic Literature Review of Clinical Outcomes Following Fusion S...

#450 A Systematic Literature Review of Clinical Outcomes Following Fusion Surgery for Discogenic Low Back Pain

Oral Posters: Quality of Spine Care

Presented by: F. Phillips


F.M. Phillips (1)
P. Slosar (2)
J. Youssef (3)
G. Andersson (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, USA
(2) SpineCare Medical Group/San Francisco Spine Institute, San Francisco, CA, USA
(3) Durango Orthopedic Associates/Spine Colorado, Durango, CO, USA


Introduction: Despite a large number of publications of outcomes of spinal fusion surgery for chronic low back pain there is little consensus on efficacy. This literature review was performed to systematically compile and categorize the published evidence for lumbar fusion surgery for discogenic chronic low back pain to provide an updated and comprehensive summary of the clinical outcomes.

Methods: A MEDLINE and Cochrane database search was performed to identify published articles reporting on validated patient-reported clinical outcomes measures (two or more of VAS, ODI, SF-36 PCS, and patient satisfaction) with minimum 12 months follow-up following lumbar fusion surgery in adult patients with low back pain due to a diagnosis of degenerative disc disease. Thirty-one total articles were identified and stratified based on level of evidence: twenty-one Level 1 (6 studies of surgery versus non-operative treatment, 15 studies of alternative surgical procedures), three Level 2, two Level 3, and five Level 4 (3 prospective, 2 retrospective). Weighted averages of each outcomes measure were computed and compared with established minimal clinically important difference (MCID) values.

Results: Fusion cohorts included a total of 3,974 patients. The weighted average improvement in Visual Analog Scale back pain was 36.4/100 [SD 12.9]; in Oswestry Disability Index 22.6 [SD 11.8]; in SF-36 Physical Component Scale 12.6 [SD 3.2]; all reaching MCID. Patient satisfaction averaged 73% [SD 4%] across studies. Radiographic fusion rates averaged 89% [SD 11%], and reoperation rates 12% [SD 11%] overall, 9.6% [SD 8%] at the index level. The results of the collective studies did not differ statistically in any of the outcome measures based on level of evidence (ANOVA, p>0.05).

Conclusions: The body of literature supports fusion surgery as a viable treatment option for reducing pain and improving function in patients with chronic low back pain refractory to non-surgical care when a diagnosis of discogenic pain can be made.