Translaminar screw fixation of the lumbar and lumbosacral spine. A 5-year follow-up.

Abstract

In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed. To evaluate the clinical results, fusion rates and complications of this posterior fusion technique in various conditions of the lumbar spine. Posterior fusion of the lumbar and lumbosacral spine is one of the possible methods to relieve pain and eliminate instability in degenerative conditions. Data in the literature support the use of internal fixation to optimize the rate of fusion. Posterior lumbar and lumbosacral fixation with translaminar screws and fusion in 173 patients with degenerative changes with or without compressive syndromes including failed back syndromes, monosegmental hypermobilities, and posttraumatic conditions were investigated. Fixation and fusion with translaminar screws was performed in 57% monosegmentally, in 40% across two segments and in 2% over three segments. Decompressive surgery was performed in addition in 52% and nucleotomy in 30% of the cases. Clinical and radiologic assessment with flexion/extension x-rays was performed in 145 (83%) patients by two independent orthopedic surgeons. After an average follow-up of 68 months (range, 52-83). Ninety-four percent of the patients showed solid bony fusion in the radiologic follow-up. Loosening of the screws was noted in 3%, and two screws were broken without apparent motion on the functional x-rays. Pain scores decreased from 7.6 before surgery to 2.9 after surgery on a 10-point pain scale. The results were further analyzed according to Stauffer and Coventry with 99 good results, 70 satisfactory results, and 4 bad results. Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.