Discectomy and Anterior Interbody Fusion for Spondylogenic and Discogenic Back Pain / 대한정형외과학회잡지

ABSTRACT

A study of the effectivity and reliability of discectomy and anterior interbody fusion with autogenous iliac bone graft for spondylogenic and discogenic back pain and/or radiating pain has been done on 48 patients who had been hospitalized at Severance Hospital between January 1976 to June 1978. To the preoperative symptoms and signs such as the presence of back pain, sciatica, muscle atrophy, sensory change, motor change, spinal motion, deep tendon reflex, S.L.R., knee-chest compression test and Patricks test were checked, and after the operation, the same symptoms and signs were checked as to how they were improved or not. The age range of patients was 17 to 64 years and 40% of them were in the 3rd decade. Before the operation, for the confirmation of the origion of the back pain, we did perform dynamograms for instability and myelograms for root compression and spinal stenosis. The approach to the lesion was mainly retroperitoneal with anterior approach. Bony union after the operation was decided by a plane roentgenogram or clinical signs, and a dynamogram in some cases. The following results were obtained from analysis of the cases studied. 1. Eighty percent of the cases showed improved back pain in postoperative 3rd day and 83% showed improved sciatica in 6 months after the operation. 2. During the operation, the operative dislcogram could be done to verify the level of the lesion and the disc degeneration, disc protrusion, bony spur, narrowing of the joint space and instability during the operation could be confirmed in direct vision, so we could perform the operation for the accurate lesion. 3. Rather than the posterior approach, the anterior approach could allow all the remnants of the disc to be removed thoroughly. 4. In anterior interbody fusion, the strut of iliac bone was firmly impacted with two blocks, so its stability could be maintained, and patient could be mobilized earlier. 5. Clinical union of bone grafts was obtained in between 3 to 6 months and 96% of the cases showed bony union in 9 months. In 14 cases of two level fusions, the bony union was delayed compared to the one level fusion. 6. After the operation, the patient could return with the brace on to the office only within three months. The brace was taken off after the bony union was verified by plane roentgenogram and dynamogram.