Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, failed-back syndrome, and lumbar instability

Abstract

Various methods of lumbosacral fusions for the treatment of degenerative spinal diseases are used clinically. Results vary greatly depending on indication, type of fusion, implants, and method of evaluation. In a retrospective clinical and radiological examination after an average follow-up time of 3.9 years this study reports on the outcome of lumbosacral distraction spondylodesis (LSDS) in a consecutive series of 147 patients being fused for the treatment of spondylolisthesis, failed-back syndrome, or lumbar instability. LSDS consists of a posterolateral fusion together with an autologous corticocancellous H-graft wedged under distraction between the spinous processes of L4 and S1. With 81.0% good and excellent results this noninstrumented fusion technique showed the best outcome in patients with spondylolisthesis, while in cases with a failed-back syndrome or lumbar instability only 62.3% excellent to satisfying outcomes were noted. The rate of pseudarthrosis was 13.6% in the whole patient group; no major complications such as nerve root damage, postoperative neurological deficits, or spinal stenosis were found.