European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Randomized Controlled Trial Clinical Trial
Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion.
Pain drawings have been used in spine surgery for diagnostic use and psychological evaluation of fusion candidates; they have rarely been used to evaluate pain status after spinal fusion. This study is a 5-year follow-up on a randomised clinical trial assigning patients to posterolateral spinal fusion with or without pedicle screw instrumentation. Patients were mailed a pain drawing and questionnaires including questions regarding work, social status, smoking status, the Dallas Pain Questionnaire (DPQ), and the Low Back Pain Rating Scale (LBPRS). ⋯ Ten percent still experience donor site pain. In general, instrumentation does not affect the amount and localisation of pain 5 years after lumbar spinal fusion surgery. The pain drawing seems to be a valuable tool when following spinal fusion patients, but its use as prognostic marker in connection with fusion surgery needs further investigation.
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Randomized Controlled Trial Clinical Trial
Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage.
The objective of our study was to assess the efficacy of Graf ligamentoplasty in comparison with rigid fixation and fusion with the Hartshill horseshoe cage for similar severity of disc degeneration. Although studies have been done on the Graf ligamentoplasty procedure and the Hartshill horseshoe cage, their efficacy has never been compared in any study. This study was done to decide whether retaining mobility and stabilizing the spine is best or stiffening the lumbar segment by fusion is preferable. ⋯ At a minimum follow-up of 2.1 years, we found that 93% of patients who had undergone Graf ligamentoplasty had a satisfactory outcome (rated "excellent" or "better") compared to 77.8% of patients who had been treated with ALIF with Hartshill horseshoe cage stabilization and fusion, when measured on the Oswestry Disability Index ( P<0.05). Retaining mobility in the lumbar segments gives better results after stabilisation with Graf ligaments than rigid fixation and fusion with the Hartshill horseshoe cage in the short term. We will be watching this cohort of patients over the next few years.