Adult spondylolisthesis treated with posterolateral lumbar fusion and pedicular instrumentation with AO DC plates.

Attainment of successful lumbar fusion in adults with spondylolisthesis has historically been unpredictable. Recent results and conclusions have been conflicting regarding the role of instrumentation in improving the fusion rate and clinical outcome in this patient population. In a retrospective multicenter clinical study, we assessed the outcome of 42 adults with spondylolisthesis who underwent posterolateral lumbar fusion by using pedicular instrumentation with AO DC plates. No attempt was made to reduce slippage. Follow-up clinical outcome was obtained from a patient questionnaire administered and assessed by an independent reviewer. Fusion status was assessed by anteroposterior, lateral, and oblique radiographs at the most recent follow-up examination. Spondylolisthesis was classified as degenerative in 21 patients and isthmic in 21 patients. Solid fusion was achieved in 32 (76%) patients; pseudoarthrosis occurred in two (5%) patients; the fusion mass was indeterminate in eight (19%) patients. Clinical outcome parameters rated 73% excellent to good and 27% fair to poor. Complications included four infections and two screw breakages. Poor results correlated strongly with cigarette smoking and multiple previous surgeries. In this study, fusion rate and clinical outcome were consistent with previous reports of adult spondylolisthesis. Rates of successful fusion varied according to the type of spondylolisthesis.

The treatment of lumbar spinal pain syndromes diagnosed by discography. Lumbar arthrodesis.

STUDY DESIGN: This retrospective review of patients whose discogenic pain syndromes were treated by lumbar arthrodesis was designed to examine the clinical efficacy of this diagnostic modality and analyze possible confounding variables. OBJECTIVES: Clinical outcome was examined with respect to status of the arthrodesis, discographic diagnosis, and demographic variables. SUMMARY OF BACKGROUND DATA: Discography continues to be a controversial diagnostic technique for spinal pain syndromes. The morphologic information provided by discography is well known. However, disagreement exists concerning the clinical utility of the pain provoked by this modality. METHODS: Forty-eight patients were included in this study. In all patients, the chief complaint was low back pain. In all patients, the definitive diagnostic technique was lumbar discography followed by computerized tomographic scanning. All patients underwent lumbar arthrodesis. Data were collected in four categories: 1) demographic characteristics, 2) physical findings, 3) results of diagnostic studies, and 4) characteristics of surgical procedures. Data from these categories were studied with respect to clinical rating and status of the arthrodesis. RESULTS: Overall, 46% were judged to have a satisfactory clinical outcome at final follow-up. Forty-eight percent were judged to have a solid arthrodesis. CONCLUSIONS: Based on the results of this study, it appears that discogenic pain syndromes can be treated by arthrodesis.

The treatment of chronic extremity pain in failed lumbar surgery. The role of lumbar sympathectomy.

Persistent lower extremity pain after unsuccessful lumbar surgery continues to be a disabling condition. The results of deafferentation procedures for radiculopathy have been disappointing. Hence, the prospect of isolating a potentially reversible component of extremity pain is quite attractive. Given the frequency with which vasomotor complaints occur in this setting, the occurrence of autonomic dysfunction seems quite plausible. Autonomic dysfunction was investigated in 17 patients who had undergone previous lumbar surgery and had chronic limb pain. Patients underwent a preblockade thermogram, sympathetic blockade, and postblockade thermograms. All patients reported substantial relief after blockade, and all underwent retroperitoneal sympathectomy. All patients were followed for at least 2 years. The clinical results were disappointing, with only one patient reporting substantial relief. Although the results of thermography initially seemed to correlate with clinical outcome, further follow-up failed to yield any correlation. Additionally, no specific combination of response to blockade or thermogram was predictive of the clinical success after sympathectomy. Now, lumbar sympathectomy is not recommended in the setting of chronic radiculopathy and persistent extremity pain.

The developmental segmental sagittal diameter in combined cervical and lumbar spondylosis.

Spondylosis diffusely affects the vertebral column but is more pronounced in the cervical and lumbar regions where mobility is greatest. Of 214 patients treated for symptomatic spinal spondylosis, 63 patients (29%) were found to have symptoms related to the cervical spine alone: 123 (58%) had symptoms relative to the lumbar spine alone; 28 (13%) were found to have symptoms relative to both the cervical and lumbar spine in a retrospective clinical study. The incidence of occurrence of a narrow spinal canal was determined. In the patients with cervical spondylosis alone, 40 patients (64%) were found to have midcervical sagittal diameters below average. Eighty-seven patients (71%) with lumbar spondylosis had spinal canals below the average measurements. In the group of patients with combined disease of the cervical and lumbar spine, 18 of the 28 patients (64%) had spinal canal diameters below the accepted average values.