title: Uni- and bilateral instrumented posterolateral fusion of the lumbar spine with local bone grafting: a prospective study with a 2-year follow-up.
abstract: METHODS
  Prospective trial.
  
  
  OBJECTIVE
  To examine the bone union and clinical results after unilateral or bilateral instrumented posterolateral fusion surgery using a local bone graft.
  
  
  BACKGROUND
  The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for bilateral multisegment fusion surgery; however, outcomes have been poor because of insufficient amounts of local bone used. This study evaluated unilateral and bilateral posterolateral fusion at 3 levels using a local bone graft.
  
  
  METHODS
  Sixty-two patients diagnosed with degenerated spondylolisthesis at 3 levels were divided into 2 groups. All underwent decompression and bilateral instrumented posterolateral fusion. However, a unilateral local bone graft was used in 32 patients and bilateral local bone graft was used in 30 patients. The amount of bone grafting, proportion of patients with bone union, duration of bone union, visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were evaluated before and 2 years after surgery.
  
  
  RESULTS
  Visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were not significantly different between the 2 groups before and after surgery (P > 0.05). The amount of local bone graft used for each segment was significantly less in the bilateral group (P < 0.05). The proportion of patients with rates of bone union and instability were 86% and 9%, respectively, in the unilateral group, but significantly poorer at 60% and 34% in the bilateral group.
  
  
  CONCLUSIONS
  If multisegment fusion (3-level fusion) is performed, bilateral local bone grafting results in a poor rate of bone union because of an insufficiency of local bone. Unilateral bone grafting is recommended because better rates of bone union and stability are achieved.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiiba University, Japan. sohtori@faculty.chiba-u.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Takana
authors.initials: T
authors.lastname: Koshi
authors.forename: Munetaka
authors.initials: M
authors.lastname: Suzuki
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamashita
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.forename: Yawara
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Ochiai
authors.forename: Shunji
authors.initials: S
authors.lastname: Kishida
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kuniyoshi
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Gen
authors.initials: G
authors.lastname: Arai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyagi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kamoda
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome