Abstract
Background
Previous studies have shown Graf ligament stabilisation procedure to give mixed results in the short to medium term. The aim of this study was to correlate the pre-operative state of the disc, multifidus muscles, age of the patient, levels operated and the clinical outcome after a mean follow-up of 47 months.
Methods
Graf ligament stabilisation procedure was carried out in 38 patients between 1996 and 1999. Their post-operative status was assessed using MacNab criteria. The postoperative follow-up was by postal questionnaires and review of the clinical notes. Disc morphology and multifidus muscle wasting was graded blindly and independently. The intra- and interobserver reliability was measured with kappa score and classified using the kappa classification of Landis and Koch. Correlation was measured with the help of Spearman correlation coefficient.
Results
Thirty-eight patients (100%) returned the questionnaires. Mean follow-up time was 47.55 months. Fifty-nine levels were operated on. Mean age was 39.68 years. The overall re-operation rate was 15.8%. The intra- and interobserver reliability was graded as good to substantial. Twenty-two patients (57.89%) were satisfied with the procedure. There was no statistically significant correlation between disc morphology, multifidus muscle wasting, sex, age, number of levels operated, the levels operated, and the satisfaction rate.
Conclusions
The indications of Graf ligament stabilisation procedure are not clear. Further work is necessary to clearly identify the indication for the procedure.
Similar content being viewed by others
References
Brechbuhler D, Markwalder TM, Braun M (1998) Surgical results after soft system stabilization of the lumbar spine in degenerative disc disease — long-term results. Acta Neurochir 140(6): 521–525
Colton T (1974) Statistics in medicine. Little, Brown and Company, Boston
Gardner A, Declerck GM, Hardcastle P, Markwalder TM, Moon MS, Salanova C, Shim YS (2000) The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low-back pain. Spine 25(2): 273–276
Gardner A, Pande KC (2002) Graf ligamentoplasty: a 7-year follow-up. Eur Spine J 11 [Suppl] 2: S157–163
Graf H (1992) Lumbar instability. Surgical treatment without fusion. Rachis 412: 123–137
Grevitt MP, Gardner ADH, Spilsbury J (1995) The Graf stabilisation system: early results in 50 patients. Eur Spine J 4: 169–175
Guigui P, Chopin D (1994) [Assessment of the use of the Graf ligamentoplasty in the surgical treatment of lumbar spinal stenosis. Apropos of a series of 26 patients]. [French] Rev Chir Orthop Reparatrice Appar Mot 80(8): 681–688
Hadlow SV, Fagan AB, Hillier TM, Fraser RD (1998) The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain. Spine 23(10): 1172–1179
Kader DF, Wardlaw D, Smith FW (2000) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55(2): 145–149
Kanayama M, Hashimoto T, Shigenobu K, Harada M, Oha F, Ohkoshi Y, Tada H, Yamamoto K, Yamane S (2001) Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg 95 [Suppl] 1: 5–10
Konno S, Kikuchi S (2000) Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with graf system stabilization. Spine 25(12): 1533–1537
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: 159–174
MacNab I (1973) Pain and disability in degenerative disc disease. Clin Neurosurg 20: 193–196
Markwalder TM, Dubach R, Braun M (1995) Soft system stabilization of the lumbar spine as an alternative surgical modality to lumbar arthrodesis in the facet syndrome. Preliminary results. Acta Neurochir 134(1–2): 1–4
Markwalder TM, Mérat M (1994) The lumbar and lumbosacral facet-syndrome-diagnostic measures, surgical treatment and results in 119 patients. Acta Neurochir 128: 40–45
Papp T, Porter RW, Aspden RM, Shepperd JAN (1997) An in vitro study of the biomechanical effects of flexible stabilisation of the lumbar spine. Spine 22(2): 151–155
Pope MH, Hanley EN, Matteri RE, Wilder DG, Frymoyer JW (1977) Measurement of intervertebral disc space height. Spine 2(4): 282–286
Rigby MC, Selmon GP, Foy MA, Fogg AJ (2001) Graf ligament stabilisation: midto long-term follow-up. Eur Spine J 10(3): 234–236
Skinner I, Mather-Brown N, Hardcastle P (1998) Comparative study of Graf stabilization and posterior fusion in the treatment of chronic symptomatic mechanically unstable low back syndrome. J Musculoskeletal Res 2(2): 89–100
Smith F, Reggie A, Wardlaw D (2001) Painful disc lesion: can modern biplanar magnetic resonance imaging replace discography. British Orthopaedic Association, Annual Congress, Birmingham, 12–14 September 2001
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Askar, Z., Wardlaw, D., Muthukumar, T. et al. Correlation between inter-vertebral disc morphology and the results in patients undergoing Graf ligament stabilisation. Eur Spine J 13, 714–718 (2004). https://doi.org/10.1007/s00586-004-0702-8
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00586-004-0702-8