Authors: Dr. Ramachandran, Prof. James Gnanadoss, Dr. Prince Solomon. Dr. Deepak
Authors Affiliations: Division of spinal disorder and surgery, Department of Orthopedics, PIMS Medical College, Pondicherry, India
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BACKGROUND: Lumbar Interbody fusion techniques (posterior, transforaminal, anterior, lateral, extreme lateral and their modifications) have become the standard of care for the management of Lumbar instability. This comparative trial (retrospective) was undertaken to assess whether addition of interbody cage with autologous bone grafts was superior to only interbody autologous bone graft in terms of interbody fusion, foraminal height maintenance, disc height restoration, lumbar lordosis, functional scores (VAS, SF36, ODI) and operative complications.
METHODS: Thirty four patients, who have been operated for single level instability ( low grade I, II lytic & degenerative spondylolisthesis of L4-5/L5-S1) with modified TLIF, were selected and grouped. Group I were only interbody grafts used (n= 19) and group II were interbody cages with bone grafts used( n= 15). All interbody work were performed by modified TLIF ( Laminectomy and facetectomy) with end plate preparation and graft/cage insertion via transforaminal approach from one side. Post operatively all patients were mobilised without corset on day 1. One month after patients were allowed for lumbar flexion and extension with back care exercises. Three months later they were allowed to return back to moderate work and to heavy work after 6 months. Clinical and radiological follow up was done for a minimum of two years. VAS SF36 and ODI score were used to document the functional outcome.
RESULTS: None of the patients in our study group had pseudoarthrosis, implant failure, adjacent segment degeneration. 0ne patient in group I had transient foot drop which recovered. One patient in group II had infection, which was adequately managed with debridement and antibiotics. Interbody Fusion, was achieved in 8 months in group I and 7 months in group II(p>.05). Pre operative VAS score was 6 in group I and 6 in group II. Post operatively it came down to 1 and 2 in grouI and I respectively (p>. 05). Preoperative ODI score in group I was 70 and 76 in group II. Post operatively it improved to 11 in group I and 20 in group II ( p>. 05). Preoperative SF36 was 27.75 in group I and 22.25 in group II, which dramatically improved to69.445 and 70.66 in group I and II, but without statistically no significant difference (p>. 05).
CONCLUSION: There was no statistically significant difference between the two groups in terms of time for Interbody Fusion, functional outcome and operative complications. Radiological parameters like maintenance of foraminal height and disc space height restoration was better with cage, but withoutstatistical difference. To concludein open procedures were cauda and roots decompressed directly there is no additional benefit for using cage over bone graft.
How to Cite this Abstract
Ramachandran. Clinico radiological outcome of Lumbar Interbody Fusion with cage and without cage in Spondylolisthesis- A comparative study.International Journal of Conference Proceedings. March 2015;(2015):24