Uni- and bilateral instrumented posterolateral fusion of the lumbar spine with local bone grafting: a prospective study with a 2-year follow-up.
ABSTRACT Prospective trial.
To examine the bone union and clinical results after unilateral or bilateral instrumented posterolateral fusion surgery using a local bone graft.
The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for bilateral multisegment fusion surgery; however, outcomes have been poor because of insufficient amounts of local bone used. This study evaluated unilateral and bilateral posterolateral fusion at 3 levels using a local bone graft.
Sixty-two patients diagnosed with degenerated spondylolisthesis at 3 levels were divided into 2 groups. All underwent decompression and bilateral instrumented posterolateral fusion. However, a unilateral local bone graft was used in 32 patients and bilateral local bone graft was used in 30 patients. The amount of bone grafting, proportion of patients with bone union, duration of bone union, visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were evaluated before and 2 years after surgery.
Visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were not significantly different between the 2 groups before and after surgery (P > 0.05). The amount of local bone graft used for each segment was significantly less in the bilateral group (P < 0.05). The proportion of patients with rates of bone union and instability were 86% and 9%, respectively, in the unilateral group, but significantly poorer at 60% and 34% in the bilateral group.
If multisegment fusion (3-level fusion) is performed, bilateral local bone grafting results in a poor rate of bone union because of an insufficiency of local bone. Unilateral bone grafting is recommended because better rates of bone union and stability are achieved.
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ABSTRACT: Introduction: The TruFUSE lumbar facet fusion system is a unique allograft milled bone dowel used to fuse facet joints. We evaluated subjects undergoing TruFUSE fusion for stable grade I spondylolisthesis and stenosis comparing operative time, length of stay, blood loss and outcome to a similar literature-based cohort of patients undergoing pedicle screw fusion (PSF). Methods: From 2009 to 2011, 41 subjects (17 M,24 F, aver. age 69.5 yr) underwent TruFUSE facet fusion along with transverse process bone fusion and laminectomy. Length of stay, operative time, blood loss and outcomes were compared to eight literature-based cohort that analyzed similar parameters following pedicle screw fusion. Results: The 41 subjects’ mean operative time for laminectomy, transverse process fusion and TruFUSE facet fusion was 106 min, with a mean blood loss of145 cm3, and a mean hospital stay of 1.7 days (77% one day). A follow-up at average six months, 33 (80%) subjects reported subjective outcomes of “excellent” or “somewhat improved”, four (10%) “unchanged” and four (10%) “worse”. Flexion and extension radiographs showed 39 of the 41 patients (95%) had spinal stability at an average six months post-op and all (100%) had signs of early fusion. Discussion: TruFUSE subjects had significantly (p < 0.0001) shorter surgeries (106 min compared to the literature data range of 185 - 240 min); significantly (p < 0.0001) shorter hospitalization (1.7 days compared to 4 - 19 days range). Mean estimated blood loss (EBL) was significantly lower (p < 0.001) (145 cm3 compared to321 cm3 and1082 cm3 range for PSF). Subjective outcome and radiographic stability were comparable between groups. Conclusion: This comparison using the TruFUSElumbar facet fusion system demonstrates improvements in length of stay, surgical blood loss, and operative time in our selected patient population compared to several published lumbar pedicle screw fusion systems outcomes. There may be potential economic benefits as a result of these improvements.Surgical Science 02/2013; 4(2):166-175.