In situ local autograft for instrumented lower lumbar or lumbosacral posterolateral fusion.

摘要

This study evaluated the effectiveness of local in situ autografts in instrumented posterolateral fusion of the lower lumbar or lumbosacral spine for treating degenerative spondylolisthesis. The subjects were 182 degenerative spondylolisthesis patients with spinal canal stenosis who, in one operation, underwent lumbar laminectomy with two-level (L3-4, L4-5 or L5-S1) transpedicle screw/rod system instrumentation and posterolateral fusion using autogenous spinous processes and laminae as the only source of bone grafts. The surgical results were assessed clinically and radiologically. All patients received follow-up for at least eighteen months. At the end of follow-up, bilateral fusion mass was radiographically confirmed in 113 (62%) patients, unilateral fusion mass was observed in fifty-seven (31%) patients, and twelve (7%) patients exhibited no fusion mass at the arthrodesis level. The clinical outcome was rated excellent/good in 138 (76%) patients, fair in thirty-five (19%) and poor in nine (5%). Use of in situ local autografts yields satisfactory clinical results in instrumented posterolateral spinal fusion. No significant correlation was noted between the level of arthrodesis and the radiological outcome, nor between the level of arthrodesis and the clinical outcome. Radiographic evaluation of bony fusion mass was not predictive of the clinical findings.