One-stage combined lumbo-sacral fusion, by anterior then posterior approach: clinical and radiological results
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ORIGINAL ARTICLE
One-stage combined lumbo-sacral fusion, by anterior then posterior approach: clinical and radiological results C. Y. Barrey • L. Boissiere • G. D’Acunzi G. Perrin
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Received: 16 August 2013 / Revised: 8 September 2013 / Accepted: 8 September 2013 / Published online: 19 September 2013 Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction We intended to prospectively evaluate the clinical and radiological results of lumbo-sacral fusion achieved by a combined approach, anterior then posterior. Material and methods 62 patients were consecutively treated at L5–S1, L4–L5 or L4–S1 for degenerative disc disease or low-grade isthmic spondylolisthesis by combined surgery. Results Mean operative time and blood loss were 209 min and 308 ml, respectively, including the two approaches. VAS, ODI and Roland–Morris scores significantly improved postoperatively at 1 year (p \ 0.005) and fusion was obtained in all cases on the CT scan at 1-year follow-up. Segmental lordosis significantly improved postoperatively (p \ 0.05) with a mean gain of 10.2 at L5–S1 and 5.5 at L4–L5. Conclusion The combined procedure meets the requested criteria for a lumbar fusion in terms of clinical results, functional outcomes, fusion rates while restoring segmental lordosis and disc height. It cumulates the advantages of the
C. Y. Barrey G. D’Acunzi G. Perrin Department of Spine Surgery, P Wertheimer Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69003 Lyon, France C. Y. Barrey Laboratory of Biomechanics, Arts et Metiers ParisTech, ENSAM, Boulevard de l’Hoˆpital, 75013 Paris, France C. Y. Barrey (&) 11 ter rue Saint-Gervais, 69008 Lyon, France e-mail: [email protected] L. Boissiere Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Place Ame´lie Raba Le´on, Bordeaux, France
anterior and posterior approach performed alone, especially for L5–S1. Keywords Spinal fusion Combined approach Lordosis Fusion rates Lumbar spine
Introduction One of the most common surgical procedures to treat degenerative diseases in the lumbar spine is represented by spinal fusion, defined as the bone fusion of the vertebrae achieved after surgery [1]. Different surgical approaches, methods of fusion, types of instrumentation and bone grafts have been developed in the past 20 years to improve the bone fusion success and clinical outcome [2–5]. Interbody fusion techniques have been developed to provide solid fixation of spinal segments while restoring a proper disc height and sagittal balance [6]. Although there is still controversy regarding the best technique, there seems to be a trend toward the use of the interbody technique, reported to achieve up to 95 to 100 % of fusion. The interbody lumbar fusions may be achieved by anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), extreme lateral approach (XLIF) or a combined approach. The purpose of this study was to prospectively evaluate a cohort of patients
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