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Can Preoperative Radiographic Parameters be used to Predict Fusion in Noninstrumented Posterolateral Fusion for Degenerative Spondylolisthesis?
MedLine Citation:
PMID:  21508884     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
STUDY DESIGN: Prospective cohortOBJECTIVE: To determine whether preoperative radiographic parameters (translation, angular motion and lateral disc height) can predict fusion status in patients with degenerative spondylolisthesis who underwent a one-level decompression and noninstrumented posterolateral fusion using autogenous iliac crest bone graft.SUMMARY OF BACKGROUND DATA: Noninstrumented posterolateral fusion is sometimes considered in patients with degenerative spondylolisthesis who do not have radiographic evidence of instability. No previous study has attempted to determine whether preoperative radiographic parameters can be used to predict successful fusion.METHODS: A prospective, randomized, controlled, multicenter clinical study was previously conducted to compared the outcomes of OP-1 (BMP-7) putty to autogenous iliac crest bone graft for one-level noninstrumented posterolateral fusion for the treatment of symptomatic degenerative spondylolisthesis with spinal stenosis. A total of 90 patients who were randomized to the autograft group form the basis of this study, 67 of whom had data on the three radiographic parameters. Preoperative and postoperative radiographs were evaluated by two independent observers. The spine was determined to be fused if there was presence of continuous bone bridging between the transverse processes, angulation of ≤ 5 degrees and translational movement of ≤ 3 mm on flexion/extension radiographs of the affected level.RESULTS: 42 of 67 (63%) patients had a radiographic fusion. The mean preoperative translation in this group was 1.87 mm (range 0.3 - 7.35 mm), the angular motion was 4.44 degrees (range 0.1 to 12.1 degrees) and the lateral disc height was 8.74 (range 0.2 to 15.34 mm). 25 of 67 (37%) patients had a radiographic pseudarthrosis. The mean preoperative translation in the pseudarthrosis group was 1.20 mm (range 0 to 3.55 mm), the angular motion was 4.66 (range 1.1 to 12.95 degrees) degrees and the lateral disc space height 8.10 mm (range 1.98 to 13.315 mm). There was no significant difference in these three parameters between the fusion and the pseudarthrosis group.CONCLUSIONS: These results indicate that preoperative radiographic parameters that may indicate the absence of gross instability in degenerative spondylolisthesis are not reliable in predicting radiographic fusion in a single-level noninstrumented fusion.
Authors:
Steven S Agabegi; Kamran Majid; Jeffrey S Fischgrund; Alexander R Vaccaro; Tushar Patel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-19
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
William Beaumont Hospital, 3535 W. 13 Mile Road, Suite 744, Royal Oak, MI 48073, Phone: 610-717-8597, Fax: 248 551-5404, Email: agabegis@yahoo.com William Beaumont Hospital, Royal Oak, MI William Beaumont Hospital, 3535 W. 13 Mile Road, Suite 744, Royal Oak, MI, Phone: 248-551-0426, Fax: 248-551-5404, Email: jsfischgrund@ comcast.net Rothman Institute, Thomas Jefferson University, Philadelphia, PA Commonwealth Orthopaedics & Rehabilitation, Fairfax, VA.
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