Results of Combined 360-Degree Fusion versus Posterior Fixation Alone for Thoracolumbar Burst Fractures / 대한신경손상학회지

OBJECTIVES: To identify the better option of treatment, we compared the surgical results and efficacy of combined anterior-posterior approach versus posterior fixation alone. METHODS: During a 10 years period from 2002 to 2011, 111 patients with thoracolumbar burst fracture was surgically managed at our institute. 25 patients were managed by a combined anterior-posterior surgery and 86 patients were managed by posterior fusion alone. Radiographs were repeated at 3, 6, 12 and 24 months after operation. Radiologic outcome was evaluated by measuring Kyphotic angulation and vertebral height and the clinical outcome was evaluated by visual analogue scale (VAS) score comparison. RESULTS: The average Cobb's angle difference between immediate post operative and last follow up was 15.0degrees in combined 360-degree fusion group and 7.5degrees in posterior surgery alone group. A corrections of vertebral body height between immediate post operative and last follow up was 2.27 mm in 360-degree fusion group while 0.59 mm in posterior fixation group. The VAS score decreased from 8.4 to 2.2 after post operation 24 months in 360-degree fusion group and the posterior surgery alone group decreased 9.3 to 6.2 after post operation 24 months. CONCLUSION: The combined anterior-posterior approach resulted in less deterioration of the kyphotic angle postoperatively and improvement of vertebral height (sagittal index). Clinical outcome was also better in the combined group.

Posterior circumferential fusion for severe lumbar stenosis of the elderly / 中国矫形外科杂志

[Objective]To evaluate the application and effectiveness of circumferential fusion for the treatment of severe lumbar stenosis of the elderly.[Method]Eighty-three elderly patients with severe lumbar stenosis were treated with circumferential fusion through one-stage posterior approach(PLIF+PLF)from November 2001 to May 2004 at author's department.Postoperative complications were observed.All patients were followed-up for 24~42 months.JOA scoring system was used to evaluate the operative outcome.Plain radiographs and CT were used to judge fusion status.[Result]All patients were able to ambulate 12~14 days after operation.Symptomatic deep venous thrombosis(DVT)happened in three patients.Ten patients had worsening pain in the back and lower extremities temporarily.At final follow-up,low back pain was relieved significantly.JOA scores improved from(13.6?3.8)points before surgery to(22.3?4.6)points.Bone fusion was achieved in all operated intervertebral spaces.[Conclusion]Posterior circumferential fusion is one of safe,effective and reasonable treatment choises for elderly patients with severe lumbar stenosis.

Application of posterior circumferential fusion in the surgery of lumbar spondylolisthesis / 中国矫形外科杂志

[Objective] To evaluate the feasibilitiy,methods and therapeautical effects of the posterior circumferential fusion (PCF) combined with short -segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesis(LSL). [Method] From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short-segmental pedicle screw system fixation. There were 15 male and 29 female, average age was 48. 6 (ranged, 31~68) years. The diagnoses of LSL and stenosis were confirmed by X-ray and CT. According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type. According to Meryerding classification of LSL, 17 patients had degree I, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis. The levels of LSL was between L4 and L5,in 18 patients and between L5 and S1 in 26 cases.[Result]The follow-up period was 18~36 months , averaged 26 months.Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery. Twenty-four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis. 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis. The effect was evaluated according to Hou Shuxun's evaluation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases. The excellent and good rate was 93.2%. No complication such as interfixation failure and nerve pedicle injury or cauda equine injury were found. All cases got bony union in 3 to 10 months (mean 4.2 months) postoperatively. All patients had normal disc height and no loss of spondylolisthesis reduction. [Conclusion] The PCF combined with short-segmental pedicle screw system fixation is reasonable options in treating the LSL. It can improve the fusion rate of the spine and maintain good intervertebral space and good lordosis of the lumbar spine. The satisfactory clinical result is relied on the completely understanding of the characteristics of PCF and short-segmental pedicle screw fixation.

Long-term Result of Circumferential Stabilization for Spondylolytic Spondylolisthesis by One Stage Posterior Approach

OBJECTIVE: The purpose of this study is to evaluate the efficacy of circumferential fusion with PLIF(posterior lumbar interbody fusion) using fusion cages and pedicle screw fixation by one stage posterior approach in the patients with spondylolytic spondylolisthesis. METHODS: Total 254 patients with spondylolytic spondylolisthesis underwent circumferential fusion during last 10 years. Among them, 117 patients could be followed for more than two years (mean follow up period: 27.4+/-5.5 months). The clinical and radiographic data were reviewed retrospectively. RESULTS: The clinical success rate according to Prolo's scale was achieved in 86.3% of patients and the solid bony fusion was occurred in 92.3%. The anterior slipping was reduced from 9.54+/-3.89mm to 3.26+/-2.46mm(p<0.001, paired t-test). Angular instability in lateral dynamic X-ray was improved in all case immediately after surgery. There were 3 cases of instrument-related complication (2.6%) such as loosening, disconnection, and cage retropulsion. CONCLUSION: The circumferential stabilization with PLIF using fusion cages and pedicle screw fixation by one stage posterior approach has been found to be an effective and safe procedure, demonstrating a high fusion rate and clinical success with a rare complications.

Comparison of PLIF with Circumferential Fusion / 대한정형외과학회잡지

PURPOSE: To investigate the necessity of additional posterolateral fusion in posterior lumbar interbody fusion (PLIF) by comparing the clinical and radiological results of PLIF with circumferential fusion. MATERIALS AND METHODS: In 22 cases of circumferential fusion and 21 cases of PLIF, clinical outcomes were analyzed by Kirkaldy-Willis method. Intensity of pain, usage of analgesics and patient's satisfaction were also investigated. The fusion rates and changes of the heights and angles of discs in fused and adjacent segments were analyzed radiologically. RESULTS: No significant radiologic differences were found between two groups in terms of fusion rate, changes of disc height and angles in fused and adjacent segments. In each group, good or excellent results were obtained in 71% and 73%, respectively. A longer operation time was needed and the amount of blood loss was larger in the circumferential fusion groups. CONCLUSION: The addition of posterolateral fusion seems to have no more advantages than PLIF only.

Soft GRAF Fixation and Posterior Lumbar Interbody Fusion in Multiple Degenerative Lumbar Diseases

As a treatment of multiple degenerative lumbar disease, there is no doubt about wide decompressive laminectomy for neural decompression. But postlamenectomy instability caused by wide decompression can provoke neurologic deteriorations and further stabilization procedures may require to improve clinical symptom. Among stabilization procedures, posterior lumbar interbody fusion and posterior fixation with transpedicular screw can provide immediate stability postoperatively. But the posterior fixation with rigid rod or plate system can cause degenerative instability in adjacent segment and hardware failure due to hyperrigidity. Therefore, authors have tried posterior soft GRAF fixation and posterior lumbar interbody fusion with cages to avoid complications of rigid fixation systems and iliac bone graft in 124 patients with multiple degenerative lumbar diseases. The angular instability was improved from 14.9degrees+/-6.4degrees to 3.4degrees+/-3.5degreespostoperatively and translational instability was decreased from 6.4mm+/-1.1mm to 1.6mm+/-1.1mm (p<0.001). The height of intervertebral disc was increased from 9.8mm+/-2.1mm to 12.2mm+/-2.4mm significantly. The new instability on adjacent segment was not apparent during follow-up period. With this procedure, 88.7% of the patients were improved clinically. Results of this study show that soft GRAF fixation and posterior lumbar interbody fusion with cage(circumferential fusion or 360degreesfusion) can provide the three column stability immediately after operation without any hardware related complications. Also, it can give more physiologic property biomechanically than rigid fixation to degenerative spinal column.