Posterior Fusion of the Lumbosacral Spine:Evaluation of the Operative Results and the Factors Influencing Them

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Abstract
The operative results of 79 patients with posterior fusion of the lumbosacral spine were evaluated on the basis of a follow-up examination performed on average 5.4 yr after operation. A method of evaluation was developed which measured the patients'' subjective improvement and working capacity. The method proved appropriate for clinical use and gave a better picture of the operative result than methods relying on the patient''s own opinion or the radiographic assessment as the only criterion. Of the patients 60% were subjectively improved, 40% had returned to their previous or a corresponding occupation and 24% had a good operative result, assessed by the method applied. A statistical analysis was performed to find the factors influencing the operative results. Age over 40 yr, heavy or moderately heavy preoperative work and over 6 mo. preoperative disability had a statistically significant, unfavorable effect on the results. In laborers in heavy occupations working capacity was seldom restored to a degree sufficient for return to their previous work. The operative technique proved reliable with 91% successful fusions, assessed from functional radiographs. Successful fusion did not imply a good operative result, although it did so more often than non-fusion. Operative fusion of the lumbosacral spine appears to have relatively little value in the treatment of patients suffering from low back pain due to lumbosacral spine instability, and factors other than purely medical or surgical have a considerable influence on the operative results.

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