Functional Limitations Due to Stiffness After Long-Level Spinal Instrumented Fusion Surgery to Correct Lumbar Degenerative Flat Back

Study Design. A retrospective analysis of functional limitations due to stiffness after long-level spinal instrumented fusion surgery to correct lumbar degenerative flat back was performed. Objective. To analysis the functional limitations in patients treated surgically for adult lumbar degenerative flat back (ALDFB) with long-level instrumented fusion to the sacrum or pelvis. Summary of Background Data. Long-level instrumented fusion for ALDFB decreases back pain and spinal deformity. On the contrary, this surgery considerably eliminates spinal range of motion. This may have the potential to impair function and ability to perform activities of daily living (ADLs). Methods. Consecutive 44 patients who underwent long-level instrumented fusion to the sacrum or pelvis for ALDFB were retrospectively included in this study. All patients were followed up for a minimum of 13 months. The Lumbar Stiffness Disability Index for Korean Lifestyle and Oswestry Disability Index were administered and analyzed to assess the impact of spinal stiffness on daily living. Cohorts were defined based on the upper instrumented vertebrae (above T10 [group 1] or below L1 [group 2]) and lower instrumented vertebrae (S1 pedicle screw [group S] or iliac bolt screw [group I]). Results. All patients showed deteriorated postoperative ADLs compared to preoperative values. Group 1 showed deterioration postoperatively compared to group 2. Group 1 showed deteriorated postoperative ADLs compared to preoperative values. In group 2, question 5 and 7 showed deterioration postoperatively compared to preoperative values, and question 2 and 10 showed improvement postoperatively compared to preoperative values. Group I showed deterioration postoperatively compared to group S. Conclusion. This study will hopefully allow surgeons to provide patients with ALDFB with a more informed explanation of expected surgery effects on specific ADLs. Level of Evidence: 3

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