O1395 INSTRUMENTED POSTEROLATERAL LUMBAR SPINAL FUSION FOR INTRACTABLE MECHANICAL LOW BACK PAIN: MEDIUM TERM RESULTS USING A DEFINED SET OF SELECTION CRITERIA

Abstract

Aim: Since 1994, we have used virtually identical criteria to the Swedish Lumbar Spine Study Group before accepting patients for instrumented posterolateral spinal fusion. We review these criteria and the surgical outcome and compare them with those of the SLSSG. Method: 26 patients underwent posterolateral lumbar spinal fusion with Moss-Miami instrumentation between 1994 and 2001 for intractable LBP. Patients selected for surgery had to meet strict inclusion criteria. These were: severe intractable LBP causing significant work or recreational disability which failed to respond to all reasonable non-operative measures; absence of leg pain; no spondylolisthesis or spondylolysis; no neurological signs; no claudication; no other pathology i.e. mechanical/discogenic LBP only; no disc protrusion on MRI; no clinical evidence of learnt illness behaviour; L5/S1 or L4/L5 black discs on MRI, and no black discs above these levels; no litigation or compensation claim in process. Patients were assessed at a minimum of 1 year (range 14–95 months) using the NASS lumbar spine follow-up form, and postoperative radiographs to assess the fusion mass. Results: There were no deaths or significant complications of surgery. 84% of patients showed substantial improvement, 16% were improved but with significant residual pain. None were unchanged or worse. Fusion rate was 92%. Only two patients would not have undergone the same procedure again. Conclusion: We believe that these criteria form a sound basis for selecting patients with severe intractable LBP who might benefit from a posterolateral fusion.