Anterior Interbody Fusion for Lower Lumbar Spinal Diseases

Kim, Hyun Nam

Abstract

There are several modalities of surgical treatment in lumbar herniated nucleus pulposus (HNP), derangement of lumbar intervertebral disk (DLID), spondylolysis, spondylolisthesis and degenerative spinal stenosis with scoliosis, such as laminectomy, laminectomy and diskectomy, laminectomy with diskectomy and posterolateral fusion, laminectomy with diskectomy and posterior lumbar intebody fusion, anterior diskectomy and interbody fusion, modification with cage instrumentation and decompression with instrumentation and posterolateral fusion. Low back pain due to the instability resulting from the removal of the nucleus pulposus was not infrequent in clinical practice. The purpose of the study was to determine the factors affecting clinical results by evaluating fusion rate, fusing pattern, measurement of spinal canal, correction of deformity. Five hundred and twenty eight cases of lower lumbar spinal diseases including 2S6 cases of lumbar HNP and DLID, 189 cases of spondylolysis and spondylolisthesis and 53 cases of spinal stenosis with scoliosis were studied respectively. The cases were admitted to Severance Hospital department of Orthopaedic Srugery from January 1970 through December 1994, and followed the patients from two years up to 15 years with an average of 2.9 years. It was reviewed clinical records and radiographs. The radiological study included plain x-ray, dynamogram, tomogram, myelography, computed axial tomography and/or MRI. It was evaluated the fusion rate, fusing pattern, area of spinal canal, correction of deformity and clinical results. The rate of solid fusion was 89.5% in lumbar HNP and DLID, 77.3% in spondylolysis and spondy-lolisthesis, and 86.7% in spinal stenosis with scoliosis. The most common type of the fusing pattern was type I in lower lumbar diseases. The satisfying clinical result was 82.6% in lumbar HNP and DLID, 76.7% in spondylolysis and spondylolisthesis and 58.5% in spinal stenosis with scoliosis. Spinal canal measurement was done in 23 cases and the increase of A-P diameter of spinal canal was 0.50+/-0.29mm and it was correlated with satisfying clinical result. Correction of the deformity was evaluated in 53 cases of spinal stenosis with scoliosis and of them 67.9% was corrected and it was correlated with satisfying clinical result. In conclusion the factors affecting the satisfying clinical results in the lower lumbar spinal diseases treated by diskectomy and anterior interbody fusion are solid union, restoration of disk height, correction of the deformity and increment of area of dural sac. Anterior diskectomy and interbody fusion have shown to be a good method of treatment for lower lumbar spinal diseases.