Mid-term clinical results of Graf stabilization for lumbar degenerative pathologies. a minimum 2-year follow-up.
BACKGROUND
Spinal fusion has some adverse effects, such as nonunion and pain at the site of grafted bone, and fusion with rigid spinal instrumentation especially may have the possibility of increasing mechanical stress on the segments adjacent to the site of fusion. The theory of the Graf system is that it will decrease adjacent disc deterioration because of maintenance of regional lordosis with flexibility and restriction of the motion of unstable segments without rigid spinal fusion.


OBJECTIVE
To assess the clinical and radiologic results of Graf stabilization for lumbar degenerative disorders with minimal or mild instability.


METHODS
This is a retrospective study examining the mid-term results of Graf stabilization.


METHODS
In total, 59 patients underwent Graf ligamentoplasty and adequate decompression from April 1993 to September 1997. The subjects were 30 men and 29 women, and the mean age at the time of surgery was 60.6 years, ranging from 23 to 82 years. The average follow-up period was 3 years and 5 months, ranging from 2 years to 5 years and 10 months.


METHODS
We evaluated the surgical results using a scoring system, a visual analog scale, and radiological measurements.


METHODS
The results were assessed according to a clinical scoring system established by the Japanese Orthopaedic Association (JOA score) and ratings based on a visual analog scale. Through analysis of x-ray images, the sagittal alignment (regional lordosis) and the range of motion (ROM) of the stabilized segments were measured in all cases, and the percentage of segments slipping and posterior disc height were determined for 29 patients with degenerative spondylolisthesis.


RESULTS
Clinical scores and low back pain ratings based on a visual analog scale were significantly improved at the time of final follow-up compared with the preoperative values. Regional alignment of the operative segments was maintained in lordosis at the time of final follow-up. Preoperative ROM was significantly reduced at the time of final follow-up. There were no statistical differences in percentage of slippage or percentage of posterior disc height between the final follow-up values and the preoperative values.


CONCLUSIONS
Our clinical results indicate that the Graf system is a suitable treatment option for mild and early lumbar degenerative diseases with minimum flexion instability of less than 10 degrees.
Department of Orthopaedic Surgery, Hakodate Central General Hospital, Honcho 33-2, Hakodate City, Hokkaido 040-8585, Japan. tomhashi@bea.hi-ho.ne.jp
T
T
Hashimoto
F
F
Oha
K
K
Shigenobu
M
M
Kanayama
M
M
Harada
Y
Y
Ohkoshi
H
H
Tada
K
K
Yamamoto
S
S
Yamane
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome