What are the Differences in Outcome among Various Fusion Methods of the Lumbar Spine?

  • Kang, Suk-Hyung (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Park, Seung-Won (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Hong, Hyun-Jong (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Min, Byung-Kook (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • 발행 : 2005.01.31

초록

Objective: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. Methods: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. Results: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B ($2.42{\pm}2.20mm$) was better than Group A ($-1.33{\pm}2.05mm$). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B($2.42{\pm}2.20mm$). Fusion rate of group C and D were higher than that of group A and D. Conclusion: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.

키워드

참고문헌

  1. Brantigan JW, Steffee AD : A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine 18 : 2106-2107, 1993 https://doi.org/10.1097/00007632-199310001-00030
  2. Briggs H, Milligan PR : Chip fusion of the low back following exploration of the spinal canal. J Bone Joint Surg 26A : 125-130, 1944
  3. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA : Posterior lumbar interbody fusion : a biomechanical comparison, including a new threaded cage. Spine 22 : 26-31, 1997 https://doi.org/10.1097/00007632-199701010-00005
  4. Cloward RB : The treatment of ruptured intervertebral disc by vertebral body fusion. indication, operative technique and aftercare. J Neurosurg 10 : 154-168, 1953 https://doi.org/10.3171/jns.1953.10.2.0154
  5. Dickman CA, Fessler RG, Macmillan M, Haid RW : Transpedicular screw-rod fixation of the lumbar spine : Operative technique and outcome in 104 cases. J Neurosurg 77 : 860-870, 1992 https://doi.org/10.3171/jns.1992.77.6.0860
  6. Enker P, Steffee AD : Interbody fusion and instrumentation. Clin Orthop 300 : 90-101, 1994
  7. Hambly MF, Wiltse LL, Raghavan N, Schneidermann G, Koenig C : The transition zone above a lumbosacral fusion. Spine 23 : 1785-1792, 1998 https://doi.org/10.1097/00007632-199808150-00012
  8. Hibbs RA : An operation for progressive spinal deformities. NY Med J 93 : 1013-1016, 1911
  9. Hutter CG : Posterior intervertebral body fusion : a 25-year study. Clin Orthop 179 : 86-96, 1983 https://doi.org/10.1097/00003086-198310000-00013
  10. Jahng TA, Kim JM : Surgical management of adult lumbar spondylolisthesis -comparison of various method. J Korean Neurosurg Soc 25 : 793-801,1996
  11. Kim YB, Park SW, Kwon JT, Min BK, Hwang SN, Suk JS, et al : Unilateral posterior lumbar interbody fusion with bone dowels. J Korean Neurosurg Soc 25 : 1202-1208, 1996
  12. Kim YB, Park SW, Hwang SN, Choi DY : The effect of additional transpedicular instrumentation for patients with symptomatic degenerative spondylosis with instability treated with posterior lumbar interbody fusion using autologous iliac bone dowel. J Korean Neurosurg Soc 32 : 102- 106, 2002
  13. King D : Internal fixation for lumbo-sacral fusion. Am J Surg 66 : 357- 367, 1944 https://doi.org/10.1016/S0002-9610(44)90201-1
  14. Louis R : Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop 203 : 18-33, 1986
  15. Oh SH, Yoon DH, Jin DK, Cho YE, Kim YS : Surgical result according to interbody fusion methods in 360$^{\circ}$ fusion for degenerative lumbar diseases. J Korean Neurosurg Soc 31 : 216-221, 2002
  16. Acke O, Magnus K, Henrik D, Ralph H, Inga R : Complication after transpedicular stabilization of the spine : A survivorship analysis of 163 cases. Spine 19 : 2774-2779, 1994 https://doi.org/10.1097/00007632-199412150-00007
  17. Park SW, Kim YB, Hwang SN, Choi DY, Kwon JT, Min BK, et al : Biomechanical effect of facet capsule injuries in posterior lumbar fusion operations. J Korean Neurosurg Soc 30 : 358-365, 2001
  18. Rechtine GR, Sutterlin CE, Wood GW, Boyd RJ, Mansfield FL : The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis. J Spinal Disord 9 : 382-391, 1996 https://doi.org/10.1097/00002517-199610000-00004
  19. Roy-Camille R, Saillant G, Mazel C : Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203 : 7-17, 1986
  20. Simmons JW : Posterior lumbar interbody fusion with posterior elements as chip grafts. Clin Orthop 227 : 99-102, 1988
  21. Stillerman CB, Schneider JH, Gruen JP : Evaluation and management of spondylolysis and spondylolisthesis. Clin Neurosurg 40 : 384-415, 1993
  22. Verlooy J, De Smedt K, Selosse P : Failure of a modified posterior lumbar interbody fusion technique to produce adequate pain relief in isthmic spondylolytic grade 1 spondylolisthesis patients. a prospective study of 20 patients. Spine 18 : 1491-1495, 1993 https://doi.org/10.1097/00007632-199318110-00014
  23. Watkins MB : Posterolateral bone-grafting for fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am 41 : 388-396, 1959 https://doi.org/10.2106/00004623-195941030-00002
  24. Wetzel FT, LaRocca H : The failed posterior lumbar interbody fusion. Spine 16 : 839-845, 1991 https://doi.org/10.1097/00007632-199101000-00007
  25. Yashiro K, Homma T, Hokari Y, Katsumi Y, Okumura H, Hirano A : The Steffee variable screw placement system using different methods of bone grafting. Spine 16 : 1329-1334, 1991 https://doi.org/10.1097/00007632-199111000-00014
  26. Zindrick MR : The role of transpedicular fixation system for stabilization of the lumbar spine. Orthop Clin North Am 22 : 333-344, 1991