Outcomes of Decompression with Multi-Segment Long Instrumented Fusion in Lumbar Degenerative Disease

Abstract

Objective: To evaluate the results of DLF in MDLS performed by a single experienced spine surgeon for both radiographic and clinical outcomes. Materials and Methods: The database of single-institution was retrospectively reviewed. To identify MDLS patients who had undergone DLF (> 2 levels) between 2007 and 2017. Clinical presentation, radiographic measurements, perioperative complications, and postoperative results were analyzed. The Oswestry disability index (ODI) and EuroQol five dimensions’ questionnaire (EQ-5D-5L) were used to evaluate the outcomes comparing the preoperative and the most recent postoperative results. Results: In total, 84 patients (23 males and 61 females) were enrolled, with an average age of 64.4±8.6 (46-81) years old. Among these, 39 patients had fusion to L5 and 45 patients had fusion to the sacrum. Mean operative time was 66.9+23.4 minutes per level (range: 22.2-140) and the average length of stay was 10.7+5.7 days (range: 5-39). The mean estimated blood loss was 290.6+168.5 ml (range: 21.4-666.7). Average follow-up was 50.0+29.8 months (range: 0.5-124). The average preoperative ODI score was 60.6+16.3 (28-97.8) and 24.2+17.3 (0-71.1) postoperatively, while the average preoperative and postoperative EQ-5D-5L scores were 0.161+0.268 and 0.818+0.225, respectively. Both these clinical scores (ODI and EQ-5D-5L) showed a statistically significant improvement (p < 0.001). Finally, 13% (11/84) of patients had further surgery. Conclusion: Decompressive laminectomy and long spinal fusion performed in patients with multi-level deteriorating lumbar spinal stenosis are safe and effective in terms of the patients’ quality of life and disability improvement.

Keywords

• Lumbar spinal stenosis
• multi-level fusion
• quality of life
• disability
• Oswestry disability index