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Friday, March 2, 2001

PLIF results in high rate of return to duty

Instrumented posterior lumbar interbody fusion (PLIF) performed in active duty U.S. servicemen with chronic back pain and single level lumbar disk degeneration results in a high rate of return to full military duty, investigators said Thursday in scientific paper 87.

They conclude in their study "servicemen treated with this technique are less likely to receive a back pain disability discharge or a permanent physical limitation profile when compared to servicemen who choose to be treated nonoperatively. Outcomes with respect to posttreatment pain, function, and satisfaction are excellent in those servicemen who are able to return to unrestricted military duty regardless of treatment."

To conduct the study, 29 consecutive U.S. active duty servicemen (average age: 36 years; range: 25 to 42 years) with > one year of chronic back pain symptoms and MRI evidence of single level lumbar disk degeneration [either isolated DDD (n = 20) or low-grade isthmic spondylolisthesis (n = 9)] were referred to the same surgeon (Major Robert W. Molinari, MD) at a military spine clinic for treatment. Each serviceman had a desire to continue his career on active duty military service.

Fifteen servicemen were treated operatively with instrumented PLIF using autogenous iliac crest bone graft, nonthreaded interbody cages (Brantigan or Harms) and pedicle screw instrumentation. A concomitant posterolateral fusion was performed in all 15 cases.

Fourteen servicemen refused surgery and were treated nonoperatively with spinal extension exercises, medications, and restricted duty. The average follow-up time was 14 months (range: 6 to 24 months). All servicemen completed a functional outcome questionnaire (AAOS/SRS) with emphasis on levels of pre- and posttreatment function, pain and satisfaction. The two groups also were evaluated using military physical training (PT) test scores before and after treatment, number of servicemen returning to full, unrestricted military duty after treatment, number of military back pain disability discharges, and the total posttreatment length of time on duty restriction profiles. Four of 14 (29 percent) of the servicemen managed nonoperatively ultimately received a disability discharge from the military for back pain, another five of the 14 (36 percent) remained on permanent duty restriction profiles, and the remaining five (36 percent) returned to full, unrestricted military duty.

In the PLIF group, 12 of the 15 soldiers (80 percent) were able to return to full duty, and the other three (20 percent) remained on permanent restrictive duty profiles. None received a disability discharge from the military for back pain.

Twelve of the 15 (80 percent) of the PLIF group and nine of the 14 (64 percent) of the nonop group were physically able to complete the posttreatment military physical fitness test. The average posttreatment PT test score was 244/300 for the nonop group and 232/300 for the PLIF group. No significant difference was observed between premorbid and posttreatment PT test scores in either group (p > .05). However, scores for patient-assessed posttreatment pain, function and satisfaction were significantly higher in the PLIF group.

Complications in the PLIF group included dural tear (n = 2), unilateral transient lower extremity paresthesia (n = 1) and wound seroma requiring reoperation (n = 1). Coauthors of the study are Dr. Molinari, and Major Tad Gerlinger, MD, both of Madigan Army Medical Center, Tacoma, Wash.

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Last modified 15/February/2001 by IS