Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Jul;467(7):1740-6.
doi: 10.1007/s11999-009-0887-6. Epub 2009 May 19.

Adjacent segment instability after treatment with a Graf ligament at minimum 8 years' followup

Yongsoo Choi  1 , Kisoo Kim, Kwangyoung So
Affiliations

Adjacent segment instability after treatment with a Graf ligament at minimum 8 years' followup

Yongsoo Choi et al. Clin Orthop Relat Res. 2009 Jul.

Abstract

Although there has been some enthusiasm over the early clinical results obtained using the Graf ligament, associated mid- to long-term results are controversial. We retrospectively reviewed 43 patients (67 segments) treated with the Graf ligament for degenerative lumbar stenosis. The minimum followup was 8 years (mean, 10 years; range, 8-14 years). At last followup, we observed angular instability in 19 of the 67 segments (28%) and translational instability in five (7%). The disc height decreased from postoperatively (mean 93% of the preoperative disc) to the final followup (mean 82%). Of the 43 patients, 18 (42%) had adjacent segmental instability at the upper segment, including angular instability in 11 patients, translational instability in four patients, and both in three patients. The adjacent segment instability at the lower segment revealed 13 patients (30%) with angular instability. The data suggest the anticipated mechanical effects of the Graf ligament can be altered by degeneration of the disc and facet joints at instrumented segments and the adjacent segment can be affected, perhaps as a result of abnormal load transmission.

Level of evidence: Level IV, therapeutic study.

PubMed Disclaimer

Figures

Fig. 1A–B
Fig. 1A–B
In a comparison of (A) a postoperative radiograph with (B) one taken 10 years 7 months after the index operation, a loss of disc height and spondylolisthesis of L4 on L5 can be seen.
Fig. 2A–B
Fig. 2A–B
In a comparison of (A) a postoperative radiograph with (B) a flexion stress radiograph taken 10 years 3 months after the index operation, translational instability is evident at the adjacent segment to L4.
Fig. 3A–D
Fig. 3A–D
For a 59-year-old female patient, a comparison of (A) a postoperative radiograph with (B) a lateral radiograph taken 14 years after the index operation shows retrolisthesis at L3–L4 and loss of disc height at L3–L5. (C) MRI reveals canal stenosis at L3–L4. (D) The patient was treated with additional decompression and conversion to fusion.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10505503', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10505503/'}]}
    2. Agazzi S, Reverdin A, May D. Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg. 1999;91:186–192. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00007632-200111150-00004', 'is_inner': False, 'url': 'https://doi.org/10.1097/00007632-200111150-00004'}, {'type': 'PubMed', 'value': '11707702', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11707702/'}]}
    2. Ariga K, Miyamoto S, Nakase T, Okuda S, Meng W, Yonenobu K, Yoshikawa H. The relationship between apoptosis of endplate chondrocytes and aging and degeneration of the intervertebral disc. Spine. 2001;26:2414–2420. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/BF01676569', 'is_inner': False, 'url': 'https://doi.org/10.1007/bf01676569'}, {'type': 'PMC', 'value': 'PMC3454634', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC3454634/'}, {'type': 'PubMed', 'value': '9093822', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9093822/'}]}
    2. Boos N, Webb JK. Pedicle screw fixation in spinal disorders: a European view. Eur Spine J. 1997;6:2–18. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00002517-199306060-00001', 'is_inner': False, 'url': 'https://doi.org/10.1097/00002517-199306060-00001'}, {'type': 'PubMed', 'value': '8130395', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/8130395/'}]}
    2. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993;6:461–472. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/BRS.0b013e31814b2d8e', 'is_inner': False, 'url': 'https://doi.org/10.1097/brs.0b013e31814b2d8e'}, {'type': 'PubMed', 'value': '17873819', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17873819/'}]}
    2. Cheh G, Bridwell KH, Lenke LG, Buchowski JM, Daubs MD, Kim Y, Baldus C. Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine. 2007;32:2253–2257. - PubMed

MeSH terms