Spine Fusion Results: Twenty Years Later
Computer searches are used in medicine to review changes and progress in treatment. Doctors from the Boston University School of Medicine conducted such a search. The topic of their study was lumbar spinal fusion.
Many changes have taken place in how spinal fusions are done. Advances in technology have also increased the number of fusions done. It's time to ask the question, "What are the results of fusion now?" These researchers looked at the results of 84 studies on spine fusion over 20 years, from 1979 to 2000. All 7043 patients had degenerative spine disease requiring fusion.
There were some major gaps in the information collected. Many studies left out important variables. For example, some studies failed to include the design of the study. Others didn't mention if they used braces after the operation. The location of the fusion and the rate of success weren't always recorded.
From the data collected, the authors saw one trend. Fusions are done more often now using some form of hardware. The hardware can be metal plates, screws, rods, or other devices to hold the bones in place until fusion occurs. Fusion with these devices is called instrumented fusion.
Despite the changes in the last two decades, the results aren't any better. The researchers were surprised to find the fusion success rate has stayed the same over all these years. The overall fusion success rate was 88 percent for all patients in the 1980s. The success rate was 87 percent in the 1990s. Fusion with instrumentation had a higher rate of success than no instrumentation. Fusion success goes down when more than one spinal level is fused.
The authors say the biggest thing they saw from this study is the need for a standard core of information collected and reported when doing studies of lumbar fusion. They suggest what types of information should be collected and placed in the database. The results will help surgeons choose the right operation for each patient in the future.
Christopher M. Bono, MD, and Casey K. Lee, MD. Critical Analysis of Trends in Fusion for Degenerative Disc Disease over the Past 20 Years. In Spine. February 15, 2004. Vol. 29. No. 4. Pp. 455-463.