The Importance of Proximal Fusion Level Selection for Outcomes of Multi-level Lumbar Posterolateral Fusion

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2015 Mar 3

PMID 25729522

Citations 4

Authors

Woo Dong Nam

Jae Hwan Cho

Affiliations

Soon will be listed here.

Abstract

Background: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes.

Methods: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors.

Results: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203).

Conclusions: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.

Citing Articles

MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure.

Kljaic Dujic M, Recnik G, Milcic M, Bosnjak E, Rupreht M J Clin Med. 2022; 11(14).

PMID: 35887716 PMC: 9321056. DOI: 10.3390/jcm11143952.

Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis.

Wang H, Sun Z, Wang L, Zou D, Li W Global Spine J. 2021; 13(1):149-155.

PMID: 33648368 PMC: 9837505. DOI: 10.1177/2192568221994082.

Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems.

Ko Y, Lee E, Lee J, Park C, Cho J, Kang Y PLoS One. 2020; 15(5):e0233633.

PMID: 32459814 PMC: 7252624. DOI: 10.1371/journal.pone.0233633.

Postoperative Evaluation of Health-Related Quality-of-Life (HRQoL) of Patients With Lumbar Degenerative Spondylolisthesis After Instrumented Posterolateral Fusion (PLF): A prospective Study With a 2-Year Follow-Up.

Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Nastoulis E, Givissis P Open Orthop J. 2018; 11:1423-1431.

PMID: 29387287 PMC: 5748841. DOI: 10.2174/1874325001711011423.

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