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Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, failed-back syndrome, and lumbar instability

European Spine Journal volume 1, pages 117–124 (1992)Cite this article

Résumé

Diverses méthodes de fusion lombo-sacrée sont utilisées dans le traitement des affections dégénératives rachidiennes. Les résultats sont très variables et dépendent de l'indicatio, du type de fusion, des implants et de la méthode d'évaluation. Par une analyse rétrospective clinique et radiologique après un délai postopératoire moyen de 3,9 mois, cette étude rend compte du résultat de la “spondylodèse lombo-sacrée en distraction” (LSDS) dans une série consécutive de 147 patients traités par arthrodèse pour spondylolisthésis, échec de la chirurgie lombaire ou instabilité lombaire. La LSDS consite en une greffe postéro-latérale associée à un greffon autologue cortico-spongieux en H enfoncé sous distraction entre les épineuses de L4 et de S1. Avec 81,0% de bons et excellents résultats, cette technique d'arthrodèse sans ostéosynthèse a montré ses meilleurs résultats dans le traitement des spondylolisthésis, tandis que dans les cas d'échec de la chirurgie lombaire ou d'instabilité lombaire il n'a donné que 62,3% des résultats excellents ou satisfaisants. Le taux de pseudarthroses était de 13,6% pour tout le groupe et l'on n'a pas trouvé de complications majeures comme une atteinte radiculaire, un déficit neurologique post-opératoire ou une sténose lombaire.

Summary

Various methods of lumbosacral fusions for the treatment of degenerative spinal diseases are used clinically. Results vary greatly depending on indication, type of fusion, implants, and method of evaluation. In a retrospective clinical and radiological examination after an average follow-up time of 3.9 years this study reports on the outcome of lumbosacral distraction spondylodesis (LSDS) in a consecutive series of 147 patients being fused for the treatment of spondylolisthesis, failed-back syndrome, or lumbar instability. LSDS consists of a posterolateral fusion together with an autologous corticocancellous H-graft wedged under distraction between the spinous processes of L4 and S1. With 81.0% good and excellent results this noninstrumented fusion technique showed the best outcome in patients with spondylolisthesis, while in cases with a failed-back syndrome or lumbar instability only 62.3% excellent to satisfying outcomes were noted. The rate of pseudarthrosis was 13.6% in the whole patient group; no major complications such as nerve root damage, postoperative neurological deficits, or spinal stenosis were found.

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Affiliations

  1. Department of Orthopaedic Surgery, Detroit, USA

    J. Möller, R. H. Wittenberg, R. Willburger & J. Krämer

  2. Bioengineering Center at Wayne State University, Detroit, USA

    L. P. Nolte

  3. Department of Radiology, St. Josef-Hospital, Ruhr University, Bochum, Federal Republic of Germany

    M. Jergas

  4. Department of Surgery, Augusta-Krankenanstalten, Bergstrasse 26, W-4630, Bochum 1, Federal Republic of Germany

    J. Möller

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  1. J. Möller
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  2. R. H. Wittenberg
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  3. L. P. Nolte
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  4. M. Jergas
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  5. R. Willburger
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  6. J. Krämer
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Möller, J., Wittenberg, R.H., Nolte, L.P. et al. Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, failed-back syndrome, and lumbar instability. Eur Spine J 1, 117–124 (1992). https://doi.org/10.1007/BF00300938

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  • DOI: https://doi.org/10.1007/BF00300938

Mots-clés

  • Rachis lombaire
  • Arthrodèse lombaire
  • Spondylolisthésis
  • Echec de la chirurgie lombaire
  • Biomécanique

Key words

  • Lumbar spine
  • Spinal fusion
  • Spondylolisthesis
  • Failed-back syndrome
  • Biomechanics