Intraarticular arthrodesis of the unstable lumbosacral spine – first results of the prospective study
Authors:
L. Hrabálek
Authors‘ workplace:
Neurochirurgická klinika FN a LF UP Olomouc, přednosta: Doc., MUDr., M. Vaverka, CSc.
Published in:
Rozhl. Chir., 2013, roč. 92, č. 9, s. 494-500.
Category:
Original articles
Overview
Introduction:
The aim of this study is the presentation of surgical treatment of the unstable lumbosacral (LS) spine using the bilateral intraarticular facet fusion.
Material and methods:
For surgical treatment patients were indicated with the degenerative instability of LS spine. We examined VAS (Visual Analogue Scale), ODI (Oswestry Disability Index), static and dynamic skiagrams and magnetic resonance imaging before surgery. Laminectomy for the decompression of the spinal stenosis and a transpedicular (TP) fixation were performed. Corticospongious bone chips from lamina were inserted into the intraarticular caves after the drilling of the facet cartilages. The study group consisted of 17 patients (the average age of 66 years), with a minimal follow-up of two years. One year after the surgery, we evaluated VAS, ODI, the improvement of walking distance, Odom criteria, complications, the stability of the spinal segment and the extent of the intraarticular fusion using Computed Tomography (CT).
Results:
VAS for the axial pain was decreased from 6.8 (in average) before surgery to 1.5 (in average) after one year; the improvement was by 77.4%. VAS for the radicular pain was decreased from 6.3 (in average) before surgery to 1.6 (in average) one year after surgery; the improvement was by 74.6%. ODI was decreased from 52.1 (in average) before surgery to 23.4 (in average) one year after surgery; the improvement was by 55.1%. According to Odom criteria we evaluated 10 patients as excellent and 7 patients as good one year after surgery.
The bone intraarticular fusion and the stability of the spinal segment according to CT scans and dynamic skiagrams were concluded in all patients (100%). The extent of the intraarticular fusion (facet area) according to CT scans was 89% in average. All patients improved their walking distance and there were no surgical complications.
Conclusion:
The intraarticular arthrodesis of LS spine was concluded in all (100%) patients during one year after surgery.
After the concomitant laminectomy, the TP fixation and the intraarticular fusion of the unstable segment of LS spine we observed a decrease of the axial pain by 77%, the radicular pain by 75% and the improvement of functional ability by 55% in comparison to the status before surgery. According to the author this surgical method is safe, cheep, and effective in certain indications of degenerative disease of LS spine, at the same time.
Key words:
intraarticular arthrodesis – lumbosacral spine – instability – degenerative spondylolisthesis – transpedicular fixation
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Perspectives in Surgery
2013 Issue 9
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