Lumbar Spinal Fusion Affects Sitting Disability on the Floor

Background: Lumbar spinal fusion is a standard of care for certain lumbar spinal diseases. However, its impact on sitting, especially on the floor, has not been assessed, even in the countries where people usually sit on the floor instead of using a chair.

Methods: A total of 100 Korean patients who underwent lumbar spinal fusion and 47 patients who underwent decompression surgery were enrolled. In a postoperative Oswestry Disability Index (ODI) questionnaire, an additional section 11 (Sitting on the Floor) was inserted, in which the phrase "sitting in a chair" of section 5 was replaced with "sitting on the floor." The ODI scores were calculated twice using either the section with "sitting in a chair" or the section with "sitting on the floor" and comparing the two.

Results: In the fusion group, the mean postoperative ODI calculated with "sitting on the floor" is significantly worse than that with "sitting in a chair" ( < .0001). This difference was the same regardless of whether the fusion was done at a single level ( < .0001) or 2 or more levels ( = .006) or whether location was at L4-L5 ( = .002) or L5-S1 ( = .02) in a single-level fusion. The scores of the decompression group showed no difference. Though preoperative and postoperative ODI showed no difference between groups, the postoperative ODI using "sitting on the floor" was significantly worse in the fusion group than the decompression group ( = .009).

Conclusion: ODI scores using "sitting on the floor" after lumbar fusion were significantly worse than those with "sitting in a chair." A sitting disability on the floor after lumbar arthrodesis has not been appreciated adequately so far and should be seriously considered if a lumbar arthrodesis is planned in a society where people's usual style of sitting is on the floor.