• F B Christensen, B Karlsmose, E S Hansen, and C E Bünger.
• Biomechanics Laboratory, Orthopedic Hospital, Aarhus N., Denmark.
• Eur Spine J. 1996 Jan 1; 5 (5): 293-8.

AbstractOutcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979-1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64 patients a supplemental facet joint fusion was performed. Clinical outcome was evaluated 5-13 years after surgery using the patient-administered Dallas Pain Questionnaire (DPQ). Radiological outcome was determined on the basis of radiographs taken at a 2-year follow-up assessed by independent observers. The radiological follow-up rate was 98%. Complete fusion was found in 52%, questionable fusion in 24%, and definitive pseudoarthrosis in 24% of patients. Radiological results were poor in patients who had undergone previous spinal surgery (P < 0.05) and in those with two-level fusion (P < 0.05). The DPQ reply rate was 80%. Sixty-six patients claimed improvement in all functional groups. Patients with complete or questionable union had significantly better results than did those with non-union (P < 0.01). Poorer functional outcome was found in patients who had undergone previous spinal surgery (P < 0.01) or fusion at the L4/L5 level (P < 0.05), in those who had responded poorly to the preoperative test brace (P < 0.05), and in those above 45 years old at the time of surgery (P < 0.05). Radiological and functional outcome did not vary according to whether patients were treated postoperatively with a plaster jacket or with facet screw fixation. The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.

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