Minimization of the number of pedicular screws placing in the degenerative lumbar spine.

OBJECTIVE: The present study was carried out to compare clinical results of spinal fusion in degenerative disease of lumbar between using pedicular screw instrumentation in every pedicle and partial placing the screws in some vertebra to provide immediate stabilization of the spine. MATERIAL AND METHOD: Fifty patients with degenerative diseases of their lumbar spines and needing spinal fusion between 2004 and 2007 were included in this study. They were divided into two groups by the order of their admissions. All underwent complete decompressive laminectomy and posterlateral fusion with autogenic bone grafting. In the first group, 25 patients received pedicular screw instrumentation at all pedicles that were in the fusion area. In the second group, 25 patients received pedicular screw instrumentation only in particular pedicles to minimize the operative time, blood loss and the cost of instrumentation. Japanese Orthopedic Association (JOA) Lumbar Scoring System was used to evaluate function outcome of the patients. RESULTS: There was no serious complication in both groups. Furthermore, there was no significant difference in terms of operative time, amount of blood loss, time to bone union, and JOA lumbar score at the one-year follow-up between the groups. However, the costs of instrumentation were significantly reduced in the second group. CONCLUSION: Minimizing the numbers of pedicular screws instrumentation for spinal fusion of degenerative spine could be carried out to lessen the cost of treatment in particular patients.

Posterolateral fusion with autogenous laminospinous process bone graft.

The results of posterolateral spinal fusion by using autogenous iliac bone graft is gold standard. However, there are some undesirable effects at the donor site. This study reports the outcome of posterolateral spinal fusion by using an autogenous bone graft from the lamina and spinous process. From June 1993 to May 2001, Decompressive laminectomy, pedicle screw fixation system and posterolateral fusion were performed on 92 patients using autogenous bone from the decompressive laminectomy procedure. The follow-up periods were 2-8 years. 97.56 per cent of the patients had a solid fusion mass at 6 months after operation. There were no undesirable effects at the iliac region. The JOA score for low back pain improved in all patients. The result of posterolateral spinal fusion by using autogenous bone from the lamina and spinous process is comparable to the autogenous iliac bone graft. The advantages of using the laminospinous process bone graft are short operating time, less blood loss than taking a bone graft from the iliac crest, no complication or undesirable effects at the iliac region.