Research

Removing instrumentation in the absence of pseudoarthrosis for the treatment of recurrent low back and leg pain is controversial. The goal was to determine if instrumentation removal was beneficial for patients with recurrent low back and leg pain following a lumbar fusion. Patients were required to have a solid fusion determined by direct, surgical inspection. Results were summarized and compared between the patients with loose instrumentation and the patients without loose instrumentation.

Both groups showed a significant improvement in pain from pre-operative to post-operative and from pre-operative to the time of survey, with greater improvement in patients with loose instrumentation. Based on a four-item change in pain scale, 80% of the patients with loose instrumentation group felt better or much better compared to 40% without loose instrumentation. (P-value=0.043)

The majority of the patients in both groups would recommend the surgery to a family member (Loose=92%, Not Loose=60%), would have the surgery again themselves (Loose=96%, Not Loose=64%), and consider the surgery a success (Loose=96%, Not Loose=54%). Although both groups had a large success rate, patients with loose instrumentation were significantly more likely to have a successful outcome than the patients without loose instrumentation.

This study demonstrates that the removal of instrumentation in the absence of pseudoarthrosis is beneficial in the relief of low back and leg pain symptoms. Increased success rates were noted in patients with loose instrumentation. However, this classification was based on inter-operative inspection. Further study of the ability to diagnose and predict success prior to surgery needs to be done.