Computer-guided percutaneous interbody fixation and fusion of the L5-S1 disc: a 2-year prospective study.
BACKGROUND
The clinical outcomes of lumbar fusion are diminished by the complications associated with the surgical approach. Posterior approaches cause segmental muscular necrosis and anterior approaches risk visceral and vascular injury. This report details a two-year prospective study of a percutaneous method which avoids the major problems associated with existing approaches.


METHODS
Seventeen patients underwent percutaneous, trans-sacral fusion and fixation of L5-S1 with the assistance of computer guidance. Each patient was followed for a minimum of two years post surgery. SF-36 questionnaires and radiographs were obtained preoperatively and at two years post-operatively. Fusion was assessed with post-operative radiographs and/or CT scan.


RESULTS
Ninety-three percent of the people fused as judged by plain AP films, Ferguson's view radiographs, and/or CT scans at the two year follow-up. Prospective health and functional SF-36 scores showed significant improvement from the preoperative to the postoperative period. There were no significant complications related to the approach or to the placement of the implants.


CONCLUSIONS
Percutaneous fusion of the lumbosacral spine appears safe and provides excellent clinical results with a minimal amount of associated tissue trauma.
Mac Millan
Michael
M
Jewett Orthopaedic Clinic, Orlando, Florida, USA. dparadise@jewettortho.com
D000328:Adult; D016025:Bone Transplantation; D002404:Catheterization / Q000592:standards; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016268:Internal Fixators / Q000592:standards; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012447:Sacrum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D012984:Software; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome