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The Long and The Short of Spinal Fusion

Spinal fusion for chronic disc-related low back pain is usually done at one to two levels. Does fusion of a longer segment cause more problems than fusion at a short segment? Researchers in this study compared two groups of patients with lumbar spinal fusion to find out.

The first group had a short fusion (one or two levels). The second group had a long fusion (three to five levels). Patients in both groups were evenly matched in terms of age, gender, and smoking and work status. Measures included pain and levels of function
(physical and social). Both groups were followed for two years.

The results showed no difference betwee the long and short group when measures of pain and function were compared. In other words quality of life (QOL) was rated the same in both groups. Differences were seen in the fusion rate. The rate of successful fusion was
much higher in the short fusion group. Patients in the long fusion group had more failed fusions and second surgeries.

The authors suggest that patients in the long fusion group did as well (QOL) as the short fusion group for two reasons. First, patients were chosen carefully based on age, type of disc problem, and symptoms. Second, each patient joined an exercise group before the surgery to improve strength and general health. Patients willing to complete the pre-
operative exercise program may be more likely to be committed to their own recovery.

References: John J. Lettice, MD, et al. Does the Number of Levels Affect Lumbar Fusion Outcome? In Spine. March 15, 2005. Vol. 30. No. 6. Pp. 675-681.

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