Chien‑Yuan Huanga,†, Kuang‑Ting Yeha,b,†, Tzai‑Chiu Yua,b, Ru‑Ping Leec, Ing‑Ho Chena,b, Cheng‑Huan Penga, Kuan‑Lin Liua, Jen‑Hung Wangd, Wen‑Tien Wua,b*
aDepartment of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, cInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, dDepartment of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
†Both authors contributed equally to this work.
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1‑year of clinical and radiological follow‑up was conducted. Intraoperative blood loss, surgical time, and any surgery‑related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient’s Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.
Keywords: Allogenous strut bone graft, Anterior interbody fusion, Lumbosacral degenerative disease, Posterior percutaneous fixationthan
