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Getting a Fix Beforehand on Whether Fusion Will Work

Heads or tails? Flip a coin and there's a 50-50 chance you'll get one or the other. The odds are only slightly better for a good result after low back (lumbar) fusion for degenerative spine conditions. Doctors would like to find a way to improve the odds for these patients.

This study reports the results of one method called temporary fixation as a possible way to predict success of lumbar fusion. The patient goes to sleep under general anesthesia. Screws are placed through the skin into the bones on the back of the lumbar spine. A special brace called an external frame is attached to the screws on the outside of the back. This keeps the spine from moving in the area that is braced.

The frame and the screws are removed eight days later. Pain and function are measured before, during, and after the brace is in place. Function is measured by speed and distance the patient can walk.

Improved pain and function after a short period of fixation are signs that spinal fusion will work. In these cases, it is thought that patients will get at least as much pain relief with a fusion surgery as they did with the brace. Some patients get even better results with fusion surgery.

The authors report that this method can be used to help predict which patients can benefit from a spinal fusion. Using such a device can save thousands of dollars for patients who might not be helped by having lumbar fusion. Researchers conclude that even better methods of patient selection for low back surgery are needed.

References: Paul Axelsson, et al. Temporary External Pedicular Fixation Versus Definitive Bony Fusion: A Prospective Comparative Study on Pain Relief and Function. In European Spine Journal. February 2003. Vol. 12. No. 1. Pp. 41-47.

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