The Effect of Pedicle Screw/Plate Fixation on Lumbar/Lumbosacral Autogenous Bone Graft Fusions in Patients With Degenerative Disc Disease

Wood, George W.; Boyd, Robert J.; Carothers, Thomas A.; Mansfield, Frederick L.; Rechtine, Glenn R.; Rozen, Michael J.; Sutterlin, Chester E.

doi:10.1097/00007632-199504000-00017

Cited by 86 publications

(37 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the clinical results, although generally better in the latter group, were not further detailed for this specific t2 entity. Wood et al [186] studied 28 patients with degenerative disc disease treated by pedicular fixation and posterolateral fusion. This study group was compared to a literature control group (eight studies, 498 cases) treated by posterior or posterolateral fusion without instrumentation for the same diagnosis.…”

Section: Low-back Pain Disordersmentioning

confidence: 99%

Pedicle screw fixation in spinal disorders: A European view

1997

View full text Add to dashboard Cite

Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

show abstract

Section: Low-back Pain Disordersmentioning

confidence: 99%

Pedicle screw fixation in spinal disorders: A European view

1997

View full text Add to dashboard Cite

show abstract

“…Since the ad- Table 2 vent of osteosynthetic spinal stabilization, the optimal choice between uninstrumented and instrumented techniques in lumbar fusion has been debated. Adjunctive spinal instrumentation seems to enhance fusion rates in degenerative disorders [13], although the risk of intraoperative and postoperative complications is somewhat increased for instrumentation [9]. Semirigid fixation systems such as the Graf technique [ 11] have been presented as alternative to rigid hardware spine fixation, but no biodegradable material has yet been tried.…”

Section: Discussionmentioning

confidence: 99%

Posterolateral lumbar fusion using facet joint fixation with biodegradable rods: A pilot study

1997

View full text Add to dashboard Cite

Roentgen stereophotogrammetric analysis (RSA) was used to assess whether there is a potential for biodegradable rods crossing the denuded facet joints to increase the stability and healing rate of lumbar posterolateral fusions. Eleven consecutive patients with lumbosacral disc/facet joint degeneration had a posterolateral fusion augmented with 2-or 3.2-mm biodegradable rods passing perpendicularly through the center of the denuded facet joints. The patients were followed-up with RSA in supine and erect positions monthly from the 2nd to the 6th postoperative month, and again 1 year postoperatively. All seven L5-S 1 fusions healed. Four cases were stable as defined by RSA within 3 months, two within 6 months, and one within 1 year. One L4-S 1 fusion could not be evaluated by RSA.None of the remaining three L4-S 1 fusions fully healed. In all three cases 1-to 3-mm intervertebral translations remained at 1 year. None of the 11 fusions showed any radiographic signs of osteolysis around the biodegradable rods. The promising results of this pilot study indicate that posterolateral L5-S 1 fusion augmented with transarticular biodegradable rods crossing the denuded facet joints may yield rapid intervertebral stabilization and a high healing rate without any adverse rod effects. This may be due to enhanced initial fusion stabilization and/or increased ossification induced by the rods.

show abstract

“…The uniaxial load cell (200 N, Burster, Germany) was placed coaxially to the cranio-caudal axis of the specimen at the end of the lever arm. As Yamamoto et al found, an axial load smaller than 150 N has no effect on the range of motion [34]. Left and right axial rotation (transversal plane) was realized by an electromechanical drive.…”

Section: Spine Testing Setupmentioning

confidence: 99%

“…The aim is to decompress the spinal cord, correct disorders and perform a fusion on the affected segments. A variety of surgical techniques (anterior, posterior and combined approach) are described in literature [2,13,34]. Still, controversy exists about the best treatment of various injury patterns.…”

mentioning

confidence: 99%

Is a single anterolateral screw-plate fixation sufficient for the treatment of spinal fractures in the thoracolumbar junction? A Biomechanical in vitro Investigation

Schreiber

Bence

Grupp³

et al. 2004

Eur Spine J

View full text Add to dashboard Cite

Controversy exists about the indications, advantages and disadvantages of various surgical techniques used for anterior interbody fusion of spinal fractures in the thoracolumbar junction. The purpose of this study was to evaluate the stabilizing effect of an anterolateral and thoracoscopically implantable screwplate system. Six human bisegmental spinal units (T12-L2) were used for the biomechanical in vitro testing procedure. Each specimen was tested in three different scenarios: (1) intact spinal segments vs (2) monosegmental (T12/L1) anterolateral fixation (macsTL, Aesculap, Germany) with an interbody bone strut graft from the iliac crest after both partial corpectomy (L1) and discectomy (T12/L1) vs (3) bisegmental anterolateral instrumentation after extended partial corpectomy (L1), and bisegmental discectomy (T12/L1 and L1/L2). Specimens were loaded with an alternating, nondestructive maximum bending moment of ±7.5 Nm in six directions: flexion/extension, right and left lateral bending, and right and left axial rotation. Motion analysis was performed by a contact-less three-dimensional optical measuring system. Segmental stiffness of the three different scenarios was evaluated by the relative alteration of the intervertebral angles in the three main anatomical planes. With each stabilization technique, the specimens were more rigid, compared with the intact spine, for flexion/extension (sagittal plane) as well as in left and right lateral bending (frontal plane). In these planes the bisegmental instrumentation compared to the monosegmental case had an even larger stiffening effect on the specimens. In contrast to these findings, axial rotation showed a modest increase of motion after bisegmental instrumentation. To conclude, the immobilization of monosegmental fractures in the thoracolumbar junction can be secured by means of bone grafting and the implant used in this study for all three anatomical planes. After bisegmental anterolateral stabilization a sufficient reduction of the movements was registered for flexion/extension and lateral bending. However, the observed slight increase of the range of motion in the transversal plane may lead to loosening of the implant before union. Therefore, the use of an additional dorsal fixation device should be considered.

show abstract

The Effect of Pedicle Screw/Plate Fixation on Lumbar/Lumbosacral Autogenous Bone Graft Fusions in Patients With Degenerative Disc Disease

Cited by 86 publications

References 0 publications

Pedicle screw fixation in spinal disorders: A European view

Pedicle screw fixation in spinal disorders: A European view

Posterolateral lumbar fusion using facet joint fixation with biodegradable rods: A pilot study

Is a single anterolateral screw-plate fixation sufficient for the treatment of spinal fractures in the thoracolumbar junction? A Biomechanical in vitro Investigation

Contact Info

Product

Resources

About