There have been no studies looking at the long-term follow-up of service personnel following spinal fusion. The activities demanded by service life exert significant strain on the axial spine and there are no figures documenting the return to full service post-surgery.

A retrospective review of theatre records and case notes was made of 65 service personnel who had undergone spinal fusion at the Royal Hospital Haslar between 1990 and 2000 and the following recorded: mechanisms of injury, Service, sex of patient and age of patient at operation, the type of operation performed (instrumented v in situ fusion) and final medical category upon discharge from follow-up or from the Service.

A comparison of previously published indications for spinal fusion was made.

65 patients were identified as Service personnel undergoing spinal fusion, of which 53 were entered into the study. 48 males, 5 females average age 33.16 yrs. 35/53 (66%) spondylolisthesis, 8/53 multi-level degenerative disc disease, 4/53 (7.5%) post-discectomy instability. 33/53 (62.2%) in-situ fusion, 20/53 (37.7%) instrumented fusion.

18/53 (33.9%) are still serving of whom 5/53 (9.43%) are back to full fitness. 23/53 (43.4%) were given a medical discharge.

Spinal fusion in service personnel has similar results to those that have been published previously. A full occupational assessment at initial OPD with preoperative rehabilitation as well as post-operative rehabilitation is required to maximise the potential of return to full fitness. In military patients, even apparent successful surgery is not indicative of return to full fitness. For a service perspective, successful surgery is that which returns a service person back to their operational role.

Common pre- and post-operative details were obtained.

For a service environment, successful surgery would result in the return of a service person back to their operational role.

INTRODUCTION: Chronic back ache is a common disorder which rarely indicates surgery. There are accepted indications for surgical intervention; namely that of neurogenic leg pain in the presence of spondylolisthesis or gross instability of the lower lumbar segments. There have been no studies looking at the long term follow-up of service personnel following spinal fusion. The activities demanded by service life exert significant strain on the axial spine and there are no figures documenting the return to full service post-surgery.

METHOD: A retrospective review of case notes of service personnel undergoing spinal fusion at the Royal Hospital Haslar was performed from 1990 onwards. 65 patients were identified and their case notes analysed. The following information was obtained:

Age, sex, pre-operative diagnosis, medical category pre-op, non-operative treatment, surgical procedure, post-operative rehabilitation, medical category post-surgery and whether still serving.

ANALYSIS: Outcome parameters: medical category post surgery, and ability to continue serving in the armed services.

DISCUSSION: Successful results from spinal surgery depends on good patient selection and the development of a treatment protocol. From a service perspective, a successful surgical outcome would result in the return of a service person back to their operational role. We discuss a potential treatment algorithm for the surgical management of low back pain.