Research

INTRODUCTION:
Low back pain related to symptomatic lumbar disc degeneration (SLDD) is a common problem. Reluctance in offering surgical fusion for patients with multiple levels (3 or more) of disc degeneration continues. This study reviews the outcome of combined anterior/posterior arthrodesis with instrumentation for SLDD involving 3 or more discs.

MATERIAL and METHODS:
All patients had a diagnosis of SLDD, documented non-surgical treatment for at least 6 months, and three or more involved levels confirmed by MRI and discography. Anterior fusion included tricortical allografts; posterior fusion included autogenous iliac graft and pedicle screw instrumentation. A total of 82 consecutive patients were included and followed for a minimum of 2 years (average=4 years).

RESULTS:
The population consisted of 41% male, age 25 to 73 years, 67% had previous lumbar surgery and 44% were receiving workmen's compensation. Solid fusion at all levels was achieved in 70 of 82 patients (85%). Complications included 2 patients (2.4%) with deep wound infections and 2 patients (2.4%) with neurological/radicular problems. Junctional degenerative changes and/or instability were present in 22 patients (27%). Seventy-four percent of patients rated improvement as MUCH BETTER or BETTER. Overall, 33 patients (40%) returned to work.

CONCLUSION:
The radiographic results of circumferential fusion with segmental pedicle fixation for multiple level (3 or more) SLDD indicated high success rates (85%). Approximately three-fourths of the patients indicated improved symptoms.