European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Bisphosphonates are compounds characterized by a P-C-P structure. They act essentially on bone, inhibiting bone resorption. Through this mechanism they decrease bone loss, increase bone mineral density, and decrease bone turnover. ⋯ In the latter they diminish both vertebral and nonvertebral fractures. The adverse events are few, mostly gastrointestinal, and can be avoided to a large extent by correct administration. Since there are no other compounds available which have a similar profile, they represent today the drugs of choice in the treatment and the secondary prevention of osteoporosis.
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Pseudarthrosis remains a significant problem in spinal fusion. The objective of our study was to investigate the effects of autologous growth factors (AGF) in instrumented transforaminal lumbar interbody spinal fusion (TLIF). A prospective review was carried out of 23 patients who underwent TLIF with application of AGF, with a minimum 2-year follow-up. ⋯ Excluding the cases with pseudarthrosis, there was faster bony healing in patients who had been treated with AGF application. This study indicates that although AGF may demonstrate faster fusions, it does not result in an overall increase in spinal fusion rates. Further studies are needed before AGF can routinely be used as an adjunct in spinal fusion.
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Randomized Controlled Trial Clinical Trial
Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion.
Pain drawings have been used in spine surgery for diagnostic use and psychological evaluation of fusion candidates; they have rarely been used to evaluate pain status after spinal fusion. This study is a 5-year follow-up on a randomised clinical trial assigning patients to posterolateral spinal fusion with or without pedicle screw instrumentation. Patients were mailed a pain drawing and questionnaires including questions regarding work, social status, smoking status, the Dallas Pain Questionnaire (DPQ), and the Low Back Pain Rating Scale (LBPRS). ⋯ Ten percent still experience donor site pain. In general, instrumentation does not affect the amount and localisation of pain 5 years after lumbar spinal fusion surgery. The pain drawing seems to be a valuable tool when following spinal fusion patients, but its use as prognostic marker in connection with fusion surgery needs further investigation.
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Comparative Study
Anterior lumbar interbody fusion: does stable anterior fixation matter?
The purpose of this study was to compare the outcome of anterior lumbar interbody fusion without instrumentation (uninstrumented ALIF) against that with stable anterior cage fixation using Hartshill horseshoe instrumentation (ALIF-HH) for similar severity of disc disease. Between April 1994 and June 1998 the senior author N. R. ⋯ On subjective score assessment, there was a satisfactory outcome (score0.05). On classification by the Oswestry Index into four categories, we found no difference in outcome between the two groups: 83.3% ( n=20) had a satisfactory outcome (defined as Excellent or Better) with ALIF and 77.8% ( n=21) had a satisfactory outcome with ALIF-HH using the Oswestry Disability Index for post-operative assessment ( P>0.05). The results of this study indicate that the Hartshill horseshoe cage does improve the fusion rate, but does not affect clinical outcome.
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In a prospective cohort study in 94 patients with 3 years' follow-up the efficacy of rigid and semi-rigid transpedicular instrumentation for lumbar spine fusion was evaluated via three established scores. Patient groups were similar in respect of anthropometric data. ⋯ Selecting implant rigidity on these criteria led to results with an improvement rate well within the upper success range reported in the literature. Among people in employment, a lengthy preoperative sick leave was an important predictor for unsatisfactory outcome.