Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria
Journal of Surgery
Volume 6, Issue 4, August 2018, Pages: 97-100
Received: Jun. 7, 2018;
Accepted: Jun. 27, 2018;
Published: Jul. 21, 2018
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Ode Michael Bundepuun, Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
Taiwo Femi Olu, Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
Onche Icha Inalegwu, Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
Amupitan Idumagbodi, Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
Ode Gloria Nengi, Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instrumented posterolateral fusion (PLF) is one of the options employed and has a reduced cost owing to the absence of the inter body cage used in inter body fusion techniques. The objective of this study was to assess posterolateral fusions in our center within a developing country with poor health insurance coverage as an effective treatment modality in degenerative lumbosacral spine disease, without the added cost of an interbody fusion cage. This was a retrospective study carried out in Jos, Nigeria covering a two year period from July 2015 to June 2017. Patients with degenerative spine diseases who had been on conservative methods of treatment for more than six months with no significant improvement were recruited for the study. Data was obtained from the case records of the patients the patients were assessed for the indications for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10) and the complications of the procedure. Data was analyzed using the epi info statistical software. 13 patients had Posterolateral fusion (PLF) within this period. The mean age was 61.4years ±10.7. A male female ratio of M:F 1:3.3. 8(61.5%) patients had multiple level disc degeneration and herniation, 2(15.4%) patients each had spinal canal stenosis and facet joint arthritis with instability and 1(7.7%) had degenerative spondylolisthesis. 9(69.2%) patients had 2 level fusion, 2 (15.4%) had 3 level fusion and 2(15.4%) had 1 level fusion. 6(46.2%) had a pain reduction by ≥ 8 points on the numeric pain scale, 6(46.2%) had reduction by 6-7 points and 1(7.7%) had reduction of 3-5 points. 92.6% of the patients had a pain reduction by more than 50%. Mean operative time was 203minutes, and mean transfusion requirement was 2.8 pints of blood. Complications noted were superficial surgical site infection 1 patient and dural tear 1 patient. Postero lateral fusion techniques are a safe and effective treatment modality in treating patients with degenerative lumbosacral spine disease. The non usage of the interbody fusion cage provides a cheaper alternative in posterolateral fusion and every modality to limit surgical site infection should be employed to limit increased cost from this complication.
Ode Michael Bundepuun,
Taiwo Femi Olu,
Onche Icha Inalegwu,
Ode Gloria Nengi,
Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria, Journal of Surgery.
Vol. 6, No. 4,
2018, pp. 97-100.
Ong KL, Auerbach JD, Lau E, Schmier J, Ochoa JA. Perioperative outcomes, complications, and costs associated with lumbar spinal fusion in older patients with spinal stenosis and spondylolisthesis. Neurosurgical focus. 2014; 36 (6):E5.
Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S. Epidemiological trends in spine surgery over 10 years in a multicenter database. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2018.
Norton RP, Bianco K, Klifto C, Errico TJ, Bendo JA. Degenerative Spondylolisthesis: An Analysis of the Nationwide Inpatient Sample Database. Spine. 2015; 40 (15):1219-27.
Robinson Y, Michaelsson K, Sanden B. Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery. A study of 1,310 patients with degenerative disc disease from the Swedish Spine Register SWESPINE. Acta orthopaedica. 2013; 84 (1): 7-11.
Pannell WC, Savin DD, Scott TP, Wang JC, Daubs MD. Trends in the surgical treatment of lumbar spine disease in the United States. The spine journal: official journal of the North American Spine Society. 2015; 15 (8): 1719-27.
Campbell RC, Mobbs RJ, Lu VM, Xu J, Rao PJ, Phan K. Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis. Global spine journal. 2017; 7 (5): 482-90.
Lubelski D, Alentado VJ, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, et al. Variability in Surgical Treatment of Spondylolisthesis Among Spine Surgeons. World neurosurgery. 2018; 111: e564-e72.
Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, et al. Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. Spine. 2016; 41 (11):978-86.
Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. The spine journal: official journal of the North American Spine Society. 2015; 15 (2):265-71.
Macki M, Bydo M, Weingart R, Sciubba D, Wolinsky JP, Gokaslan ZL, et al. Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone. Clinical neurology and neurosurgery. 2015; 138: 117-23.
McAnany SJ, Baird EO, Qureshi SA, Hecht AC, Heller JG, Anderson PA. Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis. Spine. 2016; 41 (23): E1408-E14.
Omidi-Kashani F, Hasankhani EG, Rahimi MD, Khanzadeh R. Comparison of functional outcomes following surgical decompression and posterolateral instrumented fusion in single level low grade lumbar degenerative versus isthmic spondylolisthesis. Clinics in orthopedic surgery. 2014; 6 (2): 185-9.
Noorian S, Sorensen K, Cho W. A systematic review of clinical outcomes in surgical treatment of adult isthmic spondylolisthesis. The spine journal: official journal of the North American Spine Society. 2018.
Goz V, Rane A, Abtahi AM, Lawrence BD, Brodke DS, Spiker WR. Geographic variations in the cost of spine surgery. Spine. 2015; 40 (17): 1380-9.
Doherty J, Kirigia D, Okoli C, Chuma J, Ezumah N, Ichoku H, et al. Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa. Global health action. 2018; 11 (1): 1461338.
Gottschalk MB, Premkumar A, Sweeney K, Boden SD, Heller J, Yoon ST, et al. Posterolateral Lumbar Arthrodesis With and Without Interbody Arthrodesis for L4-L5 Degenerative Spondylolisthesis: A Comparative Value Analysis. Spine. 2015; 40 (12): 917-25.
Carreon LY, Glassman SD, Kantamneni NR, Mugavin MO, Djurasovic M. Clinical outcomes after posterolateral lumbar fusion in workers' compensation patients: a case-control study. Spine. 2010; 35 (19): 1812-7.
Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, et al. Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurgical focus. 2018; 44 (1): E3.
Mina C, Carreon LY, Glassman SD. Impact of Lumbar Fusion on Health Care Resource Utilization. Spine. 2016; 41 (4):353-7.
Davis R, Auerbach JD, Bae H, Errico TJ. Can low-grade spondylolisthesis be effectively treated by either coflex interlaminar stabilization or laminectomy and posterior spinal fusion? Two-year clinical and radiographic results from the randomized, prospective, multicenter US investigational device exemption trial: clinical article. Journal of neurosurgery Spine. 2013; 19 (2):174-84.
Xiao R, Miller JA, Sabharwal NC, Lubelski D, Alentado VJ, Healy AT, et al. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system. Journal of neurosurgery Spine. 2017; 26 (5):628-37.
Zhou ZJ, Zhao FD, Fang XQ, Zhao X, Fan SW. Meta-analysis of instrumented posterior interbody fusion versus instrumented posterolateral fusion in the lumbar spine. Journal of neurosurgery Spine. 2011; 15 (3):295-310.
De la Garza-Ramos R, Abt NB, Kerezoudis P, McCutcheon BA, Bydon A, Gokaslan Z, et al. Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012. Neurological research. 2016; 38 (2):117-23.
Chotai S, Sivaganesan A, Parker SL, Wick J, Stonko DP, McGirt MJ, et al. 106 Effect of Complications Within 90 Days on Cost-Utility Following Elective Surgery for Degenerative Lumbar Spine Disease. Neurosurgery. 2016; 63 Suppl 1:145.
Shimizu T, Fujibayashi S, Takemoto M, Otsuki B, Kimura H, Ota M, et al. A multi-center study of reoperations within 30 days of spine surgery. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016; 25 (3):828-35.
Ojo OA, Owolabi BS, Oseni AW, Kanu OO, Bankole OB. Surgical site infection in posterior spine surgery. Nigerian journal of clinical practice. 2016; 19 (6):821-6.