We present our experience of 22 patients with low grade degenerative lumbar spondylolysthesis with stenosis (21 Grade I and 1 Grade II) who were treated using new stabilization systems {Scient'x IsoBar TTL Dynamic Rod Stabilization and the Inlign™ Multi-Axial pedicle Screws (Disc Motion Technologies - DMT)}. The pain intensity was evaluated using the Visual Analogue Score for back pain (VAS-BP) and leg pain (VAS-LP) and functional outcomes using Oswestry Disability Score (ODS). Overall improvement in general patient's health was assessed using the Bodily Pain (SF36-BP) component of the SF -36 questionnaires. Data was analysed with the SPSS 16.0 for Windows (SPSS Inc, Chicago, IL). Statistical significance was designated at p < 0.05 and appropriate parametric (Paired sample t-test) and non parametric tests (Wilcoxon signed-rank test) were used. There were 3 male and 19 female patients and average age at operation was 68.95 years (57-79 years). The average duration of follow up was 16.18 months (8-37 months). Most common level of surgery was L4/5 (n=18). Decompression and instrumentation involved 1 level (7 cases), 2 levels (9 cases), 3 levels (1 case) and 4 levels (5 cases). There was statistically significant improvement in all clinical outcomes. The ODS improved from 49.45 ±14.35 pre-operatively to 22.91 ± 6.38 post operatively (p< 0.001). There was statistically significant improvement noted in VAS-BP (p< 0.001), VAS-LP (p<0.001) and SF36-BP (p=0.002).Introduction
Methodology and Results
To examine the relationship between obesity (BMI> 30) and the incidence of peri-operative complications, outcome of surgery and return to work in patients undergoing elective less invasive posterior lumbar inter-body fusion of the lumbar spine for low back pain and leg pain (“LI-PLIF”). 15 patients with BMI> 30 who underwent (“LI-PLIF”) were identified by reviewing the clinical notes and the pre-operative admission sheet from April 2005- to March 2007. All had suffered chronic low back pain for a minimum of 2 years that had proven unresponsive to conservative treatment. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index (ODI), short-form 36 (SF-36), and visual analogue scores (VAS). Minimum follow-up was for 12 months. Blood loss was dependent on BMI, number of levels, and surgical time. Post operative complication was more in the morbidly obese group than the in the obese. 10 patients (66.6%) returned to their normal pre-operative employment within the 12 months of the index procedure. There was a significant improvement in the ODI and in the VAS for back pain. Length of hospital stay was a mean of 3.3 days Although surgery is technically more demanding our experience with less invasive posterior inter-body fusion has shown less incidence of post operative complication, less intra-operative blood loss and short in-patient hospital stay. We conclude that a high BMI should not be a contraindication to surgery in patients with degenerative low back pain. Ethics approval: None: Audit Interest Statement None
The aim of this study is to review the functional outcome of the patients treated with Posterior Lumbar Interbody Fusion for FBSS. This is a retrospective review of prospectively collected data of 39 patients diagnosed with FBSS and treated with PLIF between June 2000 and December 2008 by the senior author in our unit. Pain and function were evaluated by VAS for Back (VAS-BP) & leg pain (VAS-LP), Oswestry disability index (NDI) and SF-36 questionnaires, and were completed pre- & post-operatively. There were 39 patients (20 women & 19 men) and mean age at operation was 47.3 years (range of 32 to 76.1 years). Mean duration of follow-up was 39.14 months (range 5.21 -73.5 months). Thirty-one patients were diagnosed as Post laminectomy syndrome and 8 patients as post-discectomy syndrome. The mean pre and post-operative ODI values were 54.13 and 29.14 respectively. The mean pre-operative VAS back and leg pain scores were 7.38 and 6.51 respectively. The mean post-operative VAS for back and leg pain scores were reduced to 4.05 (Pre-op:7.38) and 3.69 (Mean pre-op 6.51)respectively. The mean preoperative SF-36 bodily pain component score was 27.42 and the mean postoperative score was 40.50. Four patients had uncomplicated dural tears that resolved completely. Two patients had superficial wound infection that resolved with oral antibiotics. PLIF is one of the safe and effective treatment option for FBSS and it has shown good results in our series.
