Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Abstract

Introduction. This study reported the clinical and functional
outcomes in a consecutive series of patients with
3- or 4-level degenerative disc disease (DDD) between
vertebral levels L2 to S1, who were treated with combined
anterior lumbar interbody fusion (ALIF) and posterior
spinal fusion at one-year and two-year follow-ups.

Methods. A retrospective chart review was performed on all
patients who underwent long segment fusion for DDD by a
single surgeon between August 2002 and January 2012. Fiftyfive
patients were identified and 32 had complete charts for review
(14 had one-year follow-up and 18 two-year follow-up).
In addition to demographic data, disability (Oswestry Disability
Index, ODI), pain level (Visual Analog Scale, VAS), and
flexion-extension range-of-motion were measured pre- and
post-operatively. Operative data also were collected, including
operative time, blood loss, surgical implants used, surgical
approach, operative levels treated, and complications.
Results. Both VAS and ODI improved significantly postoperatively.
The average VAS score improved from 6.5 ± 1.5
(range: 4 - 9) to 4.4 ± 1.7 (range: 2 - 7) for one-year follow-up,
and 7.0 ± 1.8 (range: 4 - 10) to 4.4 ± 2.6 (range: 1 - 9) for twoyear
follow-up. For one-year follow-up, the average ODI score
improved from 53 ± 19% (range: 18 - 70%) to 37 ± 17% (range:
12 - 64%), and for two-year follow-up, the average improved
from 53 ± 18% (range: 18 - 80%) to 31 ± 24% (range: 2 - 92%).
The level of improvement in pain and function was similar to
previously published data for 1- and 2-level fusions, but overall
pain and function scores were worse in this study group.

Conclusions. Arthrodesis for 3- and 4-level DDD is, on average,
a successful surgery that shows clinically significant
improvements in function and pain similar to fusion
for 1- and 2-levels with low rates of re-operation. Patients
with involvement of 3- or 4-levels have higher disability
and pain both pre- and post-operatively compared to shorter
fusion level involvement. KS J Med 2016;9(3):50-53.