Circumferential fusion by posterior approach in lumbosacral instability with or without pedicle screw fixation: a comparison of methods.

Lumbosacral circumferential fusion, a method which is widely adopted for the treatment of the different causes of lumbar pain, may be carried out in a single stage by posterior approach, associating interbody fusion with cages with posterolateral fusion. During the same operation, pedicle screw fixation may also be performed. In order to evaluate the need for this final surgical stage represented by pedicle screws, a comparison was conducted in 2 groups of patients affected with lumbosacral instability, treated at the Division of Vertebral Surgery at the Rizzoli Orthopaedic Institute between May 1995 and May 1997. The best clinical results were obtained in the first group (where pedicle fixation was associated). Because of the persistance of pain symptoms, successive pedicle fixation was instead required in a high percentage of patients (45%) in the second group (without pedicle fixation).