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A minimum 10-year follow-up of posterior dynamic stabilization using Graf artificial ligament

STUDY DESIGN: A retrospective long-term follow-up study. OBJECTIVES: To report minimum 10-year follow-up results of posterior dynamic stabilization using Graf artificial ligament and to evaluate the role and limitations of this procedure in the treatment of degenerative lumbar disorders. SUMMARY OF BACKGROUND: Motion-preserving surgeries, including artificial disc replacement and ligamentoplasty, are increasingly gaining interest to avoid adverse effects of spinal fusion, but literature addressing long-term results is sparse. METHODS: A total of 56 consecutive patients who underwent Graf ligamentoplasty were reviewed at a minimum 10-year follow-up. Forty-three patients in the original cohort had sufficient clinical and radiographic follow-up for analysis. The pathologies included degenerative spondylolisthesis in 23 patients, disc herniation with flexion instability in 13 patients, spinal stenosis with flexion instability in 4 patients, and degenerative scoliosis in 3 patients. Single-level procedures were performed in 36 patients; multilevel procedures were performed in 7 patients. Radiographic and clinical assessments were performed before surgery and at the final follow-up. RESULTS: Disability due to low back pain and/or sciatic symptoms was significantly improved in the patients with degenerative spondylolisthesis or flexion instability. However, degenerative scoliosis and/or laterolisthesis were associated with poor clinical improvement. In radiographic assessment, segmental lordosis was maintained in 10.9 degrees, and flexion-extension motion was averaged 3.6 degrees at the final follow-up. Facet arthrodesis eventually occurred in 14 patients (32.6%) at an average of 82 months after surgery. Additional surgeries were required in 3 patients (7.0%) for adjacent segment pathologies. CONCLUSION: The long-term results showed that Graf ligamentoplasty is an effective treatment option for low-grade degenerative spondylolisthesis and flexion instability. However, this procedure has limitations to correct spinal deformity, and is not advocated for the treatment of degenerative scoliosis and laterolisthesis

Keywords : Adult,adverse effects,Aged,analysis,Arthrodesis,Back Pain,Cohort Studies,diagnostic imaging,Female,Follow-Up Studies,Humans,Ligaments,Articular,Lordosis,Low Back Pain,Lumbar Vertebrae,Male,methods,Middle Aged,Motion,Pain,pathology,Patients,Prostheses and Implants,Radiography,Retrospective Studies,Scoliosis,Spinal Diseases,Spinal Fusion,Spinal Stenosis,Spine,Spondylolisthesis,standards,surgery,, Minimum,10year,Followup,Posterior, iliohypogastric nerve pain

Date of Publication : 2007 Aug 15

Authors : Kanayama M;Hashimoto T;Shigenobu K;Togawa D;Oha F;

Organisation : Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan. mkanayama@aol.com

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/17700446

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