Outcomes of Instrumented and Noninstrumented Posterolateral Lumbar Fusion

Abstract

The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of posterolateral lumbar fusion for lumbar stenosis cases requiring bilateral facetectomy in conjunction with a laminectomy. The authors evaluated 34 consecutive patients who had undergone a lumbar laminectomy, bilateral partial facetectomy, and posterolateral fusion at a single institution between 1981 and 1996. They included 25 men and 9 women with a mean age of 42 years (range, 27–57 years). Twenty-three cases were instrumented and 11 were noninstrumented. Mean follow-up was 21 years (range, 15–29 years). Outcomes evaluated included reoperation rate, clinical outcomes evaluated by the Oswestry Disability Index (ODI) score, radiographic evaluations of adjacent segmental degeneration (ASD) and lumbar lordosis, and contributing demographic factors to disease progression. At final follow-up, 17 of the 34 patients had undergone reoperation (43% of the instrumented group and 64% of the noninstrumented group). There were no differences in the reoperation rate or ODI improvement between the instrumented and noninstrumented groups (P>.05). Female patients required more revisions, had less ODI improvement, had greater postoperative ASD, and had less maintenance of their postoperative lumbar lordosis. There was no difference in maintenance of postoperative lumbar lordosis or ASD between the instrumented and noninstrumented groups. Instrumentation did not improve revision rates, clinical outcomes, or radiographic outcomes in laminectomies requiring contemporaneous facetectomies.

Numerical simulations of bone remodelling and formation following nucleotomy

“…Therefore, as was observed in animal studies, a nucleotomy with access to the vertebral vascular network might be as successful as instrumented fusion approaches (Crisco et al, 1990;Foster et al, 2002;Reitmaier et al, 2017;Toth et al, 2017). Not only animal studies have demonstrated the possibility of self-fusion, but some clinical studies have focused on the ability of the tissue to heal itself, producing similar outcomes with and without additional fixation (Jäger et al, 2003;Pourtaheri et al, 2015). In the present study, the cartilaginous EPs were entirely removed and the central region of the EP was exposed to the vascular network.…”

“…Rather, controlled instability (by allowing antero-posterior segmental translations of 2 mm) was found to enhance bone formation in sheep (Foster et al, 2002). Additionally, in humans, facetectomy is a part of the non-instrumented posterolateral fusion approaches with equal postoperative patient satisfaction compared to instrumented surgeries (Pourtaheri et al, 2015), and can result in stabilisation in patients with proven degenerative spondylolisthesis (Pateder and Benzel, 2010).…”

Comparison of synthetic bone graft ABM/P-15 and allograft on uninstrumented posterior lumbar spine fusion in sheep

“…There are no previous studies that have used ABM/P-15 in this challenging PLF model. The use of ABM/P-15 in this study was comparable with clinical settings and the clinical use of graft material, and is therefore highly clinically relevant [5, 6].…”

“…Spinal fusion is a procedure where bone graft material is used to facilitate novel bone formation between two adjacent vertebral bones. The aim of fusion is to segmentally impair movement and stabilization, and the procedure may be performed with or without instrumentation [5, 6]. Many different approaches have been tried, and posterior, anterior, and interbody fusion between vertebral bodies are commonly used [7, 8].…”