title: Rationale, biomechanics, and surgical indications for Graf ligamentoplasty.
abstract: Graf ligamentoplasty stabilizes the unstable segment through coaptation of bilateral facet joints. Intervertebral disc height should be preserved to avoid postoperative neuroforaminal stenosis. Biomechanically and clinically, this procedure has the potential to treat "flexion instability" but cannot correct vertebral slippage or scoliotic deformity. Surgical indication or patient selection is the key to successful ligamentoplasty. The surgical indication is degenerative lumbar disorder with less than 25% of vertebral slip, minimal disc space narrowing, and coronal facet tropism. In the long-term, Graf ligamentoplasty may reduce the risk of adjacent-segment deterioration compared with spinal fusion.
authors.affiliation: Department of Orthopaedic Surgery, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585, Japan. mkanayama@aol.com
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kanayama
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Keiichi
authors.initials: K
authors.lastname: Shigenobu
mesh_terms: D001696:Biomechanical Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D009984:Orthopedic Fixation Devices; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome