Many level fusion?

Hello All.
Does anyone know or have several levels fused in the lumber spine? If so how is life.
Thanks
Gil

This is to move this thread back to new post?

[Slackwater]

Originally Posted by mango

Hello All.
Does anyone know or have several levels fused in the lumber spine? If so how is life.

I know one gentleman who had two levels fused who was somewhat active, a passive sailor. His son told me about it and I thought, OK, Fusion. However, his son told me the fellow had root canals without
anesthesia, so ...

No personal experience. Read some of the below. Your mileage may vary, ... I have another journal article, will look for a moment, ...


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PMID: 15770184
Spine. 2005 Mar 15;30(6):675-81.
Does the number of levels affect lumbar fusion outcome?

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PMID: 17268274
Spine. 2007 Feb 1;
Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures

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CNS 2007 March: 250. Two-Level Lumbar Arthroplasty: Results in 117 Patients

Matthew Scott-Young, FRACS, MBBS, Carly Magno, BSC, David Nielsen, BSC

Introduction: Two-level lumbar arthroplasty is a more exacting procedure than one-level arthroplasty and demands technical expertise and stringent criteria for patient selection that result in good clinical outcomes.

Methods: A total of 117 patients with two-level lumbar degenerative disease underwent lumbar arthroplasty with the Charite® Artificial Disc over a period of 10 years. Treatment was performed at L3-5 in 8 cases and at L4-S1 in 109 cases. Both prospective and retrospective data collection techniques were used. Clinical outcomes were measured using ODI, VAS (back and leg), Roland-Morris, SF-36questionnaires, and work status. Patients were assessed preoperatively; at 3, 6, 12, and 24 months; and annually thereafter.

Results: Mean follow-up was 31.0 months (3-93 months). Results at latest follow-up vs. baseline were: mean ODI reduced to 18.0 from 48.3 (-63%); mean back VAS reduced to 2.4 from 7.8 (-69%); mean leg VAS reduced to 1.6 from 5.4 (-70%); mean RM reduced to 4.8 from 16.7 (-71%); mean SF-36 PCS increased to 43.8 from 28.4 (+54%), mean SF-36 MCS increased to 51.4 from 35.7 (+30%). There were 4 (3.4%) revision procedures at the index level but none at adjacent levels. At 12 months postoperatively, 100% of patients enrolled in a rigorous rehabilitation program were employed compared to 52% not enrolled.

Conclusion: Two-level lumbar arthroplasty provides a high level of clinical benefit in patients with multi-level degenerative disease. Exceptional patient selection and exacting technique must be utilized to reproduce these results.

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CNS 2007 March: 317. Simultaneous Lumbar Arthroplasty & Arthrodesis– The Hybrid Procedure: Clinical Results, 93 Patients

Matthew Scott-Young, FRACS, MBBS, Carly Magno, BSC, David Nielsen, BSC

Introduction: Multi-level lumbar arthroplasty may be contraindicated in patients with multi-level degenerative disease. In these patients, simultaneous arthroplasty and arthrodesis (a hybrid procedure) may provide the benefits of motion-sparing technology, without necessitating fusion of all of the affected levels.

Methods: A total of 93 patients with multi-level lumbar degenerative disease underwent a hybrid arthoplasty/arthrodesis procedure. In this series, 58 had lumbar arthroplasty at one-level and simultaneous lumbar arthrodesis at a second level; 31 had two-level arthroplasty adjacent to an arthrodesis, and 4 had one-level arthroplasty adjacent to a two-level arthrodesis. Clinical data were collected prospectively prior to surgery and at 3, 6, 12, and 24 months postoperatively. Clinical outcomes were measured using ODI, VAS (back and leg), Roland-Morris, and SF-36 questionnaires.

Results: Mean follow-up was 10.6 months (3-32 months). Results at latest follow-up vs. baseline were: mean ODI reduced to 18.2 from 47.5 (-62%); mean back VAS reduced to 1.9 from 7.5 (-75%); mean leg VAS reduced to 1.6 from 5.8 (-72%); mean RM reduced to 4.8 from 16.6 (-71%); mean SF-36 PCS increased to 45.4 from 28.5 (+59%), mean SF-36 MCS increased to 51.9 from 40.5 (+28%). There were no revisions at either the index levels or any adjacent levels.

Conclusion: This is the largest series of hybrid lumbar arthroplasty/arthrodesis cases reported to date. Though the follow-up in this series is limited, the clinical outcomes are excellent in patients with multi-level disease and symptomology. Further study of hybrid procedures for multi-level lumbar degenerative disease from other investigators is recommended to confirm these results.

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Spine 04/01/07: Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain (h)

PMID: 17414918
Mirza SK, Deyo RA.
Center for Cost and Outcomes Research, and Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA 98104-2499, USA.

STUDY DESIGN: Systematic review of randomized trials comparing surgical to nonsurgical treatment of discogenic back pain. OBJECTIVE: Compare research methods and results.

SUMMARY OF BACKGROUND DATA: Recent reports have increased debate about the role of surgery in the treatment of chronic back pain associated with lumbar disc degeneration. We conducted a systematic review of randomized trials comparing lumbar fusion surgery to nonsurgical treatment of chronic back pain associated with lumbar disc degeneration.

METHODS: A literature search identified 5 randomized trials that compared fusion to nonoperative treatment for chronic low back pain. Excluding 1 trial for spondylolisthesis, we compared study participants, interventions, analyses, and outcomes in 4 trials that focused on nonspecific chronic back.

RESULTS: All trials enrolled similar subjects. One study suggested greater improvement in back-specific disability for fusion compared to unstructured nonoperative care at 2 years, but the trial did not report data according to intent-to-treat principles. Three trials suggested no substantial difference in disability scores at 1-year and 2-years when fusion was compared to a 3-week cognitive-behavior treatment addressing fears about back injury. However, 2 of these trials were underpowered to identify clinically important differences. The third trial had high rates of cross-over (>20% for each treatment) and loss to follow-up (20%); it is unclear how these affected results.

CONCLUSIONS: Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy. Methodological limitations of the randomized trials prevent firm conclusions.


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Slackwater_SF
mva, 2-level lumbar surgical candidate

[Slackwater]

Originally Posted by Slackwater

Your mileage may vary, ... I have another journal article, will look for a moment, ...

A data set follows, thought I just read an abstract on multi-level ADR , TDR , TDA from Dr. Zigler / Texas. I recall another abstract about multi-level Fusion outcomes, allow me to search for a bit.

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2007 International Society for Study of the Lumbar Spine (ISSLS)
Link - Abstract Specific:

UP TO 5-YEAR PROSPECTIVE RESULTS OF 1, 2, AND 3-LEVEL LUMBAR ARTHROPLASTY WITH THE PRODISC-L DEVICE AT A SINGLE INSTITUTE
Ben B Pradhan, MD MSE; Michael A Kropf, MD; Hyun W Bae, MD; Linda EA Kanim, MA; Rick B Delamarter,
MD, Santa Monica, CA, USA

Introduction.
Artificial discs have been approved by the US FDA as an alternative to fusion in intractable degenerative disc disease. The ProDisc-L is the only device designed and tested in the US clinical trials for multi-level (1 and 2) degenerative disc disease. 3-level lumbar arthroplasties have also been performed under a “compassionate use” allowance by the FDA.

Understanding the benefits of arthroplasty, it is even more advantageous over fusion when it comes to treating multiple levels, since multi-level fusion can be considerably more morbid and stiffening.

Methods.
This is a prospective study of 245 patients with lumbar arthroplasty at a single institute with the ProDisc-L device. There were 116 1-level, 105 2-level, and 24 3-level implantations. Follow-up is up to 5 years now, and the results are reported in terms of Oswestry Disability Index, Visual Analog Scale for pain, Visual Analog Scale for patient satisfaction, and flexion-extension range of motion.

Results.
As reported in the past for earlier follow-up, the improvements in disability, pain, and patient satisfaction continue to be maintained at final follow-up for 1, 2 or 3-level disc replacements. There is a trend to increased benefit after multi-level arthroplasty, which correlates to increased preoperative disability. There have been no device-related complications, although there have been a handful of reoperations which will be illustrated. No adjacent segment problems have been detected yet.

Discussion.
The results indicate that lumbar arthroplasty with the ProDisc-L device has shown significant benefits in pain and disability reduction, is holding up to the test of the rigorous USFDA standards, and holding up to the test of time thus far at about 5 years. Multi-level arthroplasty has obvious advantages to multi-level fusion, and DDD is unfortunately often not isolated to a single level at L4–5 or L5-S1. This device appears to be well-suited for this scenario.
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ISSLS, Scoliosis Research Society, Cervical Spine abstracts archives are Link-Archives .

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Slackwater_SF
mva, 2-level lumbar surgical candidate