Pseudarthrosis at L5-S1 after Posterolateral Lumbar Fusion

조규정; 박승림; Jeong，Jae-Hoon; 원만희

Study Design: This is a retrospective study. Objectives: We wanted to investigate the rate of pseudarthrosis at L5-S1 after posterolateral fusion only for degenerative lumbar spinal disease, and to determine the radiological findings that help diagnose pseudarthrosis. Summary of the Literature Review: The pseudarthrosis rate at L5-S1 is much higher than that at the other lumbar segments. However,there have been few studies for the rate and risk factors of pseudarthrosis at L5-S1. Materials and Methods: A total of 88 patients who underwent pedicle screw instrumentation and posterolateral lumbar fusion were evaluated with a minimum of 1-year follow up. Bony union was evaluated by the bony fusion mass, the angulation on the flexionextension radiographs and the radiolucent zone around the pedicle screws. The patients’ age, bony mineral density, the number of fused segments and lumbar lordosis were evaluated for their association with pseudarthrosis at L5-S1. Results: Pseudarthrosis developed in 22 patients at L5-S1 and in 8 patients at other levels. The change of angulation on the flexionextension radiographs at the last follow-up was 5.2° in the pseudarthrosis group and 1.7° in the fusion group (P=0.3). A radiolucent zone of the sacral screws was noted in 10 patients; in 7 of the 22 patients in the pseudarthrosis group and in 3 of the 66 patients in the fusion group. The average age, the mean number of levels fused and the bone mineral density were similar in both groups. Lumbar lordosis was not associated with the development of pseudarthrosis at L5-S1. Conclusion: The pseudarthrosis rate was significantly higher at L5-S1 than that at the other lumbar segments following instrumented posterolateral fusion. Pseudarthrosis was closely related to hypermobile angulation (≥5°) on the flexion-extension radiographs and a radiolucent zone around the sacral screws.

Citation status

KCI Citation Counts (0)
REFERENCES (20)
열림/닫힘 버튼
* 2021년 이후 발행 논문의 참고문헌은 현재 구축 중입니다.

[journal] Thomsen K / 1997 / 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study / Spine 22 : 2813~2822

[journal] Moller H / 2000 / Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis-a prospective randomized study: part 2 / Spine 25 : 1716~1721

[journal] Allen BL Jr / 1984 / The Galveston technique of pelvic fixation with L-rod instrumentation of the spine / Spine 9 : 388~394

[journal] Boachie-Adjei O / 1991 / Management of adult spinal deformity with combined anterior-posterior arthrodesis and Luque-Galveston instrumentation / J Spinal Disord 4 : 131~141

[journal] Camp JF / 1990 / Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study / Spine 15 : 932~941

[journal] Saer EH 3rd / 1990 / Long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis. An improved method / Spine 15 : 650~653

[journal] Kim YJ / 2006 / Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases / Spine 31 : 2329~2336

[journal] Lenke LG / 1992 / Results of in situ fusion for isthmic spondylolisthesis / J Spinal Disord 5 : 433~442

[journal] Jackson RP / 1993 / The iliac buttress. A computed tomographic study of sacral anatomy / Spine 18 : 1318~1328

[journal] Shirado O / 1991 / Biomechanical evaluation of methods of posterior stabilization of the spine and posterior lumbar interbody arthrodesis for lumbosacral isthmic spondylolisthesis. A calf-spine model / J Bone Joint Surg Am 73 : 518~526

[journal] Cho KJ / 2009 / Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis / Eur Spine J 18 : 531~537

[journal] Brodsky AE / 1991 / Correlation of radiologic assessment of lumbar spine fusions with surgical exploration / Spine 16 : 261~265

[journal] Kim YJ / 2006 / Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis / J Bone Joint Surg Am 88 : 721~728

[journal] Wimmer C / 1998 / Aseptic loosening after CD instrumentation in the treatment of scoliosis: a report about eight cases / J Spinal Disord 11 : 440~443

[journal] Tokuhashi Y / 2008 / Clinical course and significance of the clear zone around the pedicle screws in the lumbar degenerative disease / Spine 33 : 903~908

[journal] Sanden B / 2004 / The significance of radiolucent zones surrounding pedicle screws. Definition of screw loosening in spinal instrumentation / J Bone Joint Surg Br 86 : 457~461

[journal] McAfee PC / 1991 / Survivorship analysis of pedicle spinal instrumentation / Spine 16 : 422~427

[journal] Ohlin A / 1994 / Complications after transpedicular stabilization of the spine. A survivorship analysis of 163 cases / Spine 19 : 2774~2779

[journal] Roy-Camille R / 1976 / Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles / Reconstr Surg Traumatol 15 : 2~16

[journal] Lee KY / 2002 / Metal failure of pedicle screw system / J Korean Soc Spine Surg 9 : 157~163

KJC Korea
Journal Central

Statistics

Tools

Sharing

Issue List

Citation status