Comparision of Outcome in Lumbar Spine Instability Treated Surgically with Pedicle Screw Fixation with OR Without Interbody Fusion Device(Cage)'

摘要

BACKGROUND & OBJECTIVES:Lumbar spine instability has been surgically managed by posterior lumbar interbody fusion devices using pedicle screw and rod fixation.Many surgeons advocate the use of an interbody fusion device (Cage) to assist in fusion and increase the stability of the construct.The aim of the study is to assess and compare the functional and radiological outcome of patients undergoing surgical fixation with or without interbody cage.METHODS:20 Patients were studied in Department of Orthopedics in Jiang Bin Hospital, Affiliated Hospital of Jiangsu University, who are diagnosed with instability of lumbar spine and willing for surgery.Clinical follow-up at 6wks, 3months, 6months, 12months intervals regarding pain, fusion and the functional outcome will be evaluated by visual analogue scale (VAS) pain rating, and Oswestry Disability Index (ODI) and AP , Lateral and Flexion-Extension radiographs.RESULTS:In our study, l0 patients were included in each of two groups treated with PLIF with Cage or Bone graft alone.Average age was 46.3 yrs in BG group and 47.4 yrs in cage group.Both groups showed improvement in pain and disability scores as measured by VAS, ODI, SF-36.Fusion rates at 3, 6 months and 1 year in BG group fusion rates were 0,30％ and 90％ as compared to Cage group were O, 50％ and 100％ respectively.30％ had sensory disturbance in BG group and 10％ in Cage group.Complications were screw loosening 20％, non-union 10％, Urinary disturbance 10％ in BG group and Deep infection 10％ in Cage group.Both groups had intra-op CSF leak of 10％ each.All patients returned to Pre-injury status except 1(10％) in BG group.INTERPRETATION & CONCLUSION Addition of an interbody fusion device (Cage) helps in greater stability, lower implant failure, higher fusion rate and better functional outcome in patient treated with PLIF for lumbar spine instability.We conclude solid fusion would correlate with good functional outcomes in patients with unstable lumbar segments.PLIF with Cage is associate with lesser complication rate and better patients satisfaction in terms of pain relief.

目录

声明

LIST OF ABBREVIATIONS USED

ABSTRACT

TABLE OF CONTENTS

INTRODUCTION

1．Disc Degeneration

2．Degeneration of Posterior Elements

3．Stenosis

4．Degenerative spondylolisthesis

OBJECTIVES OF THE STUDY

REVIEW OF LITERATURE

A)RELEVANT LUMBAR SPINE ANATOMY

B)BIOMECHANICS

C)APPROACH TO FUSION

MATERIAL AND METHODS

INCLUSION CRITERIA

EXCLUSION CRITERIA

PRE-OPERATIVE WORK UP

RESULTS

1．Age and sex distribution

2．Level of instability

3．Mode of instability

4．Bloodloss

5．Functional result

6．CLINlCAL EVUALATION

7．Radiological Fusion

8．Neurological status

9．Complications

DISCUSSION

1．Age and sex distribution

2．Level of instability

3．Clinical outcome

4．Radiological Outcomes

5．Complications

6．Follow up

CONCLUSION

SUMMARY

BIBLOGRAPHY