POSTEROLATERAL LUMBOSACRAL FUSION WITH TRANSPEDICULAR FIXATION - 63 CONSECUTIVE CASES FOLLOWED FOR 4 (2-6) YEARS

We analyzed the clinical, vocational and radiologic outcomes of 63 con secutive posterolateral lumbosacral fusions performed with transpedicu lar fixation. The indication for surgery was long-standing intractable lumbar and/or radiating pain with spondylolysis-olisthesis in 31 case s, degenerative disc disease and/or facet joint arthrosis in 23 cases and pain after laminectomy/decompression in 9 cases. Radiographic unio n was finally achieved in 30 out of the 63 cases. Fixation device-rela ted complications, such as screw misplacement, breakage, bending and l oosening, occurred in 33 cases. 15 patients underwent refusion. 43 pat ients obtained good pain relief. There was no correlation between bony healing and a good clinical outcome. 28/49 preoperatively employed pa tients returned to work. There was no correlation between relief of pa in and return to work. 20 patients retired on a full disability pensio n. The clinical results were best in the spondylolysis-olisthesis grou p. Only 2/15 patients with markedly reduced spondylolisthesis maintain ed the reduction. In 3 patients, progressive disc degeneration above t he level of fusion was observed. We conclude that posterolateral lumbo sacral fusion with transpedicular fixation provides a satisfactory cli nical outcome in patients with spondylolysis-olisthesis, but the high incidence of complications related to the fixation device in the other indications studied is a serious drawback of the method.