Abstract
Lumbar spine fusion (LSF) surgery is an established method in the treatment of several spinal pathologies. Those conditions are usually encumbered with substantial pain and disability, and thus impaired quality of life, which may also result in depressive symptoms. Prior literature is ambiguous whether depressive symptoms compromise LSF outcome. Mostly, knowledge of the long-term outcome of LSF surgery is limited. A major cause of recurring spinal problems beyond LSF is adjacent segment disease (ASD). Its pathogenesis is not fully understood. Pre-existing literature is conflicting whether sagittal alignment in LSF predisposes to ASD.
Aim of this thesis was to evaluate the long-term outcome of LSF surgery. The 5- year outcome was investigated on a prospective follow-up of elective LSF patients (n=523). Outcome measures included the Oswestry disability index (ODI), and the SF-36 health-related quality of life (HRQoL) survey. Those and mortality were compared to a matched general population sample (n=682). Influence of depressive symptoms on the 5-year outcome (n=392) was scrutinized using the Depression scale (DEPS) and ODI. All spinal reoperations were explored from the hospital records to determine the 10-year rates of revision surgeries for ASD. Rates were compared across surgical indications (n=365). Postoperative lumbar sagittal alignment was determined from standing radiographs. Effect of poor balance on the risk of revision for ASD was evaluated (n=215).
Generally, the benefits of LSF on disability and HRQoL were sustained at 5 years. Mortality was not increased. Depressive patients gained similar benefits with their non-depressive counterparts. In addition, LSF relieved the depressive symptoms. Isthmic spondylolisthesis infrequently became complicated with ASD (4.8%) whereas revisions for ASD accumulated almost linearly over time after LSF for degenerative spinal disorders (21%). Effect of postoperative sagittal alignment on ASD development could not be demonstrated.
Aim of this thesis was to evaluate the long-term outcome of LSF surgery. The 5- year outcome was investigated on a prospective follow-up of elective LSF patients (n=523). Outcome measures included the Oswestry disability index (ODI), and the SF-36 health-related quality of life (HRQoL) survey. Those and mortality were compared to a matched general population sample (n=682). Influence of depressive symptoms on the 5-year outcome (n=392) was scrutinized using the Depression scale (DEPS) and ODI. All spinal reoperations were explored from the hospital records to determine the 10-year rates of revision surgeries for ASD. Rates were compared across surgical indications (n=365). Postoperative lumbar sagittal alignment was determined from standing radiographs. Effect of poor balance on the risk of revision for ASD was evaluated (n=215).
Generally, the benefits of LSF on disability and HRQoL were sustained at 5 years. Mortality was not increased. Depressive patients gained similar benefits with their non-depressive counterparts. In addition, LSF relieved the depressive symptoms. Isthmic spondylolisthesis infrequently became complicated with ASD (4.8%) whereas revisions for ASD accumulated almost linearly over time after LSF for degenerative spinal disorders (21%). Effect of postoperative sagittal alignment on ASD development could not be demonstrated.
| Original language | English |
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| Place of Publication | Tampere |
| ISBN (Electronic) | 978-952-03-2576-3 |
| Publication status | Published - 2022 |
| Publication type | G5 Doctoral dissertation (articles) |
Publication series
| Name | Tampere University Dissertations - Tampereen yliopiston väitöskirjat |
|---|---|
| Volume | 674 |
| ISSN (Print) | 2489-9860 |
| ISSN (Electronic) | 2490-0028 |