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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Comparison of two lumbar instrumentation techniques for degenerative spondylolisthesis: pedicle screw insertion before or after laminectomy and fusion

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  • E. Archavlis - Department of Neurosurgery, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Germany

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.02.07

doi: 10.3205/11dgnc112, urn:nbn:de:0183-11dgnc1126

Published: April 28, 2011

© 2011 Archavlis.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Segmental pedicle screw fixation is a popular method of spinal instrumentation. This is the first study, which compares two lumbar instrumentation techniques, with pedicle screw insertion before or after laminectomy and fusion. Our objective was to determine if there is a difference in outcome and complications between the two groups of surgically managed patients.

Methods: This study retrospectively reviewed 100 consecutive patients who underwent lumbar instrumentation, fusion and decompression for stenosis in spondylolisthesis grade I and II between March 2008 und November 2009. According to the operative sequence, in group 1 (59 cases) the placement of the pedicle screws was followed by laminectomy and then fusion, in group 2 (41 cases), laminectomy was first performed and then fusion followed by pedicle screw instrumentation. Outcomes and complications were reviewed from patient records and x-rays assessing differences between the two groups.

Results: Mean age was 50 years in both groups. Body mass index (BMI) averaged 28,8 in group 1 and 31,0 in group 2. Follow-up averaged 38 Weeks with 3 patients lost to follow-up (2 in group 1 und 1 in group 2). Average blood loss in group 1 was 349 ml and in group 2 was 621 ml (p<0,003). Average length of stay was 8,4 days in group 1 and 10,4 days in group 2 (p<0,003). Final pain assessed by visual analogue scale (VAS) improved form 6,7 to 2,4 in group1 and 6,9 to 4,4 in group 2. Major complications secondary to surgery occurred in 6 patients (%) in group1 (pneumonia, pulmonary embolus, cerebrovascular insult and misplaced instrumentation requiring revision in 3 patients) and 6 patients in group 2 (pneumonia, pulmonary embolus, misplaced instrumentation requiring revision, seroma, wound healing problems in 2 patients

Conclusions: This study found that pedicle screw insertion before laminectomy and fusion was a safe and helpful strategy. The chief advantages of the pedicle screw insertion before laminectomy and fusion compared with instrumentation after decompression and fusion included a decrease in blood loss, reduction of the operating time, shorter length of hospital stay and greater improvement in pain. The analysis of the registered postoperative complications revealed that there were not significant differences between the examined groups