The case for pedicle fixation of the lumbar spine

Abstract

Study design: This was a retrospective review of one surgeon's results using three different lumbosacral arthrodesis techniques: Group 1, no instrumentation; Group 2, Luque Rod and sublaminar wire technique; and Group 3, AO intrapedicular screw and plate technique.

Objective: To determine whether the use of metal implants results in a higher fusion rate. Once a solid arthrodesis is achieved, is this correlated with a good clinical result?

Summary of background data: Controversy persists regarding the value of the use of intrapedicular fixation to augment arthrodesis of the lumbosacral junction. Controversy also exists regarding the correlation of solid arthrodesis with relief of preoperative symptoms.

Methods: Three serial sequential populations (50 subjects each) undergoing varied primary multiple-level lumbosacral arthrodesis procedures were studied retrospectively. The ultimate clinical results of these three different surgical populations were studied after prolonged follow-up.

Results: Group one had a 14% fusion rate and a 4% complication rate. Group two had a 36% fusion rate and an 8% complication rate. Group three had a 64% fusion rate and an 18% complication rate. Complications were intraoperative dural tears and nerve root injuries. Patient satisfaction with each operative procedure to relieve preoperative low back pain was statistically correlated with whether a solid arthrodesis was obtained.

Conclusion: Intrapedicular fixation technique is the most reliable method for obtaining a solid multiple-level lumbosacral arthrodesis. Solid arthrodesis is correlated with a successful clinical result. Complications associated with the use of intrapedicular fixation were frequent but their occurrence demonstrated a "learning curve pattern."