Spontaneous spinal arthordesis in Stand-Alone Percutaneous Pedicle Screw Fixation without in situ fusion in patients with lumbar segmental instability: long term clinical, radiologic and functional outcome.

Spontaneous spinal arthordesis in Stand-Alone Percutaneous Pedicle Screw Fixation without in situ fusion in patients with lumbar segmental instability: long term clinical, radiologic and functional outcome.

World Neurosurg. 2017 Dec 06;:

Authors: Gazzeri R, Panagiotopoulos K, Princiotto S, Agrillo U

Abstract
BACKGROUND: No study to date has established how commonly spontaneous fusion occurs after stand-alone percutaneous pedicle screw fixation in adult population.
OBJECTIVE: In this retrospective single center study, the authors investigated the effectiveness, long-term solidity and safety of stand-alone percutaneous pedicle screw fixation without in situ fusion and the influence of presence or absence of fusion on the clinical outcome of patients with low-grade lumbar segmental instability.
METHODS: 88 patients with symptomatic low-grade spondylolisthesis were treated with posterior stand alone percutaneous pedicle screw fixation without bone graft. Radiographic evaluation was used to determine if spontaneous fusion or absence of fusion was present. The solid fusion and absence of fusion groups were analyzed clinically (VAS and ODI questionnaire), and with validated self-administered questionnaire.
RESULTS: Average follow up was 70.5 months (from 48 to 120 months). 45.5% of patients had radiological signs of spontaneous fusion, while 54.4% of patients showed no signs of fusion. Clinical outcome was excellent to good in 73.8% of cases (in 70.9% cases with spontaneous fusion and 67.5% of cases with absence of fusion). No significant differences in residual back and lower limb pain at VAS score was discovered between the two groups at the final follow up. At final follow up 5 out of 88 (5.6%) patients underwent revision surgery.
CONCLUSIONS: Percutaneous pedicle screw fixation offers several advantages minimizing approach related morbidity, while achieving similar clinical outcome as more traditional invasive procedures. A solid fixation without bone graft provides long-term clinical benefits. The appearance of a spontaneous solid fusion and the absence of fusion after stand-alone pedicle screw fixation were correlated in our patients to a similar improved clinical outcome in long term follow up.

PMID: 29223526 [PubMed - as supplied by publisher]

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