الفهرس 
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Abstract
A prospective clinical study with a 3-year follow-up period. Objective To evaluate the results of the instrumented posterior lumbar interbody fusion (PLIF) in cases of lumbar disorders which require fusion (+/- decompression) in terms of clinical and radiographic outcomes, and to compare these results with previous studies. Summary of background data. The clinical benefits and complications of PLIF have been studied over the past 60 years. In recent years, spine surgeons have had the option of treating low back pain caused by lumbar disorders using PLIF with machined cages, bone substitutes and posterior pedicle fixation. Materials & methods. This project was conducted at Warrington Hospital NHS trust, North-west of England. Thirty six (16 male, 20 female) patients underwent PLIF with Trabecular Metal (Zimmer,TM) spacer, augmented with Actifuse (bone substitute) and posterior pedicle screw fixation between 2007 and 2010. Our cases had been selected according to specific inclusion and exclusion criteria. All of them experienced at least 6 months of low back pain that had been unresponsive to nonsurgical treatment. Full Physical examination and investigations were performed before surgery. At each follow up interval, we obtained x-rays and patient outcome measures, including visual analogue pain scale (VAS) and Oswestry Disability Index (ODI). Fusion was assessed according to specific fusion criteria. Specific sagittal lumbar profile parameters were studied including total lumbar lordosis angle (LLA), segmental lumbar lordosis angle (SLLA), anterior disc height (ADH) and posterior disc height (PDH). vii Results. Our sample age ranged from 21 to 65 years old with a mean of 45.6. Eleven patients had two-level fusion surgery and the rest of them had only one level fused. The three pathologies were DDD (18 cases), spondylolisthesis (11 cases) and spinal stenosis in seven patients. The mean follow up was 2.47 years. ODI and VAS improvement was 60.2% and 64.8% respectively; this was statistically significant (P value < 0.05). Solid interbody fusion was achieved in 94.4% of the cases (34 pt.) and the remaining was probably fused. Lenke type A and B posterolateral fusion were detected in 80.6% (29pt) of the sample. LLA and SLLA only decreased 2.7° and 2.4° respectively. There was a reduction in the disc space height 2.1mm anteriorly and 1.6 mm posteriorly. There were only four minor complications (one superficial wound infection, one transient postoperative neuropathic pain, (1%) screw misdirection and one adjacent level disease) none of them warranted revision surgery. Conclusion. Instrumented PLIF is a safe and effective surgical treatment for low back pain caused by lumbar disorders in carefully selected cases. When performed with TM spacers and Actifuse it not only improve the clinical and radiological outcomes but also saves operative time as well as blood loss and avoids the donor site morbidities of iliac crest bone graft harvesting. Our cases had outcomes equal or superior to the outcomes in previous series. Bigger long-term studies are recommended to determine whether the benefits of new techniques that are less invasive and more expensive outweigh their associated risks. The modern spine surgeon should be proficient in using the broad range of surgical tools at his/her disposal in order to best address the painful motion segment.