• P J Slosar, J B Reynolds, J Schofferman, N Goldthwaite, A H White, and D Keaney.
• SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA. pslosar4@ix.netcom.com
• Spine. 2000 Mar 15; 25 (6): 722-6.

Study DesignA review of 141 consecutive patients who underwent instrumented circumferential lumbar fusions. Outcome was assessed by an independent third party after a minimum follow-up of 2 years.ObjectivesTo evaluate clinical outcomes and assess patient satisfaction with circumferential lumbar fusions.Summary Of Background DataCircumferential lumbar fusion has been used as a salvage procedure for revision spine surgery.MethodsData were collected from patient interviews, patient satisfaction questionnaire, and review of records and radiographs of 141 consecutive patients who underwent circumferential lumbar fusion under a single anesthetic.ResultsThere were follow-up data in 133 of the 141 patients (92%). Mean duration of follow-up was 37.2 months. There were 41 (31%) primary and 92 (69%) revision surgeries. There were 73 (55%) workers' compensation and 60 (45%) non-workers' compensation patients. There were radiographs available at 12-month follow-up in 86 patients (65%). There was solid radiographic fusion in 85 (99%) of the 86 patients. The overall complication rate was 20%. Clinical outcome was determined by the patient satisfaction questionnaire. There were 14 (11%) who chose the statement, "surgery met my expectations"; 68 (51%) who chose, "surgery improved my condition enough that I would go through it again for the same outcome"; 26 (20%) who chose, "surgery helped me but I would not go through it again for the same outcome"; and 25 (19%) who chose, "I am the same or worse compared with before surgery." There was no statistical difference in patient satisfaction between primary and revision surgeries or between workers' compensation versus non-workers' compensation groups.ConclusionsCircumferential lumbar fusion is a useful procedure for a patient with difficult reconstructive disease. There is a very high fusion rate. Overall, 62% of patients are satisfied with the result, especially those with a diagnosis of pseudarthrosis or spondylolisthesis with stenosis. Patients who are working before surgery and patients who are not injured workers also tended to progress well.

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