Results of In Situ Fusion for Isthmic Spondylolisthesis

Lenke, Lawrence G.; Bridwell, Keith H.; Bullis, David A.; Betz, Randal R.; Baldus, Christy; Schoenecker, Perry L.

doi:10.1097/00002517-199212000-00008

Cited by 315 publications

(146 citation statements)

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“…The exclusion of patients from the EX group because of subsequent fusion, however, does not seem to invalidate the results, as they were operated on at a relatively early stage after inclusion in the study, i.e., after 20,21,25,26,27,28,32,34 …”

Section: Discussionmentioning

confidence: 99%

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A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.

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Section: Discussionmentioning

confidence: 99%

“…At 2 years, 72% of patients were classified as definitely fused (Grade A) according to the Lenke scale and 92% as definitely or possibly fused (Grade A or B) [27,32]. Patients not fused (Grade C or D) were at long-term reevaluated by 3 experienced spine surgeons.…”

Section: Radiographic Analysismentioning

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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“…Plain X-ray and CT analyses After the pigs were killed, the status of the posterolateral spinal fusion was evaluated on plain posteroanterior radiographs and computed tomography (CT) images using a modified Lenke et al grading scale [11]. The modified grading scale was:…”

Section: Surgical Techniquementioning

confidence: 99%

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Zou

Egund

et al. 2004

European Spine Journal

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IntroductionBecause of the associated disturbance of spinal growth, surgery for progressive spinal deformities in very young children is a challenging task. Most foregoing studies report having used a "growing spinal instrumentation without fusion" technique in order to avoid interference with spinal growth. Harrington first described the procedure, which used a Harrington rod [10]. The "Luque trolley" technique of segmental spinal instrumentation without fusion has been used with some success [13,14,18]. Blakemore et al [1] and Morin [15] introduced segmental spinal instrumentation systems (Cotrel-Dubousset, Isola, etc) for severe spinal deformities in young children. However, in all of these procedures, spontaneous bony fusion can occur before the patients reach maturity [7,14], also causing posterior ankylosis and crankshaft [5].Abstract "Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion. Instrumentation and surgical techniques have been modified in order to prevent spontaneous posterior fusion from occurring in children. An absorbable ADCON-L gel has been shown to inhibit scar and epidural adhesions following spinal surgeries. However, little is known about its influence on spinal fusion. In the present study, a single-level intertransverse arthrodesis at L4-5 on both sides was performed on each of nine pigs. Each side was randomly designed to receive autogenous bone graft with or without ADCON-L gel. The animals were followed for 10 weeks postoperatively. A fusion rate of 78% (7/9) was obtained in the autograft treatment by plain X-ray and CT evaluation, while the autograft/ADCON-L treatment yielded a 0% (0/9) fusion rate (p=0.001). Histomorphometric evaluation revealed that the addition of ADCON-L gel to bone graft decreased bone and bone marrow formation and significantly increased fibrous tissue formation. No statistical difference between the two treatments was found in cartilage, bone surface density, osteoid surfaces or osteoclast-covered surfaces in any zone. We conclude that ADCON-L gel mixed into autogenous bone graft can delay or decrease bone formation at spinal arthrodesis sites, thus influencing the extent of spinal fusion. This accords with our hypothesis that the use of ADCON-L gel can prevent not only the occurrence of spontaneous fusion in very young scoliosis patients after instrumentation without fusion, but also re-ossification of a decompressed spinal canal.

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“…The intersomatic fusion (PLIF) was established according to the radiological criteria described by Brantigan et al, [5]. The degree of posterolateral fusion (PLF) was determined employing the method used by Lenke et al, [17].…”

Section: Methodsmentioning

confidence: 99%

Treatment of Adult Spondylolisthesis: PLIF versus PLF: Comparitive Study of Early Functional Outcome

Rn¹,

BALAKRISHNAN²

2017

J Clin Exp Orthop

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Objective: Aim of this study is to assess and compare the early functional outcomes and results of posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF) in the surgical treatment of adult spondylolisthesis.Background: Posterolateral fusion has been considered the best method for surgical treatment of adult spondylolisthesis. This technique had been widely used. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. In axial loading pull out strength and eccentric loading remains a disadvantage for PLF. The problems such as axial pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion could be improved by an operation that fused vertebral bodies.

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Results of In Situ Fusion for Isthmic Spondylolisthesis

Cited by 315 publications

References 0 publications

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Treatment of Adult Spondylolisthesis: PLIF versus PLF: Comparitive Study of Early Functional Outcome

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