One-stage combined lumbo-sacral fusion, by anterior then posterior approach: clinical and radiological results.
BACKGROUND
We intended to prospectively evaluate the clinical and radiological results of lumbo-sacral fusion achieved by a combined approach, anterior then posterior.


METHODS
62 patients were consecutively treated at L5-S1, L4-L5 or L4-S1 for degenerative disc disease or low-grade isthmic spondylolisthesis by combined surgery.


RESULTS
Mean operative time and blood loss were 209 min and 308 ml, respectively, including the two approaches. VAS, ODI and Roland-Morris scores significantly improved postoperatively at 1 year (p < 0.005) and fusion was obtained in all cases on the CT scan at 1-year follow-up. Segmental lordosis significantly improved postoperatively (p < 0.05) with a mean gain of 10.2° at L5-S1 and 5.5° at L4-L5.


CONCLUSIONS
The combined procedure meets the requested criteria for a lumbar fusion in terms of clinical results, functional outcomes, fusion rates while restoring segmental lordosis and disc height. It cumulates the advantages of the anterior and posterior approach performed alone, especially for L5-S1.
Department of Spine Surgery, P Wertheimer Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69003, Lyon, France, c.barrey@wanadoo.fr.
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Barrey
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Boissiere
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D'Acunzi
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Perrin
D000328:Adult; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome