Abstract

MANDIZVIDZA, V  and  DUNN, RN. Multilevel lumbosacral fusions: Complications and patient-reported outcome. SA orthop. j. [online]. 2015, vol.14, n.2, pp.22-26. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309.

The ageing population presents with debilitating back pain and leg pain with a background of adult spinal deformity, after a protracted period of conservative care. Sagittal balance is required to achieve a good clinical outcome; however, the surgery is associated with a high incidence of complications. AIM: To review the outcome of multilevel (>4) instrumented lumbar fusion to sacrum/pelvis performed for degenerative conditions. METHODS: A retrospective descriptive study of 47 consecutive patients from 2002 to 2012. Inclusion criterion was fusion from at least L2 to Sl/pelvis, i.e. minimum of four levels. Imaging was assessed as to the restoration of normal sagittal profile as well as subsequent fusion. EQ5D, ODI and VAS scores pre-op and at 6 months post-op were analysed. Average age at surgery was 64 years (50-78). Thirteen cases were primary and 34 revisions. Indications were axial back pain either associated with sagittal imbalance (40%) or leg pain (36%) and leg pain alone in 10%. RESULTS: The intra-operative blood loss averaged 2 222 (250-7 000) ml with 40% re-infusion from cell-saver. The average surgical duration was 268 minutes. Proximal extent of instrumentation was T2 (1), T3 (1), T4 (2), T8 (1), T9 (1), T10 (17), Tll (2), T12 (5), Ll (4) and L2 (13). TLIFs were done in 20 cases mostly at the base of the construct. Pedicle subtraction osteotomies were performed in 14 revision cases. Dural tears occurred in 14 cases, all revision cases except one. Wound infection occurred in three cases. With the exception of transient quadriceps weakness related to osteotomy, no neurological complications occurred. One patient died peri-operatively. Subsequent revision was required in 13 cases for instrumentation failure. The OSD score improved by 15.3 points on average, which is clinically and statistically significant. CONCLUSION: Long lumbar fusions remain technically demanding with a high incidence of adverse events. This is due to the nature of revision surgery and high biomechanical demands on constructs. Surgical intervention can however be justified by the desperation of the cohort in terms of pain and poor function which can be modestly improved with this intervention.

Keywords : adult deformity; sagittal imbalance; spine; complications.

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