Lumbar spine arthrodesis using pedicle screws is a surgical technique performed in the reconstruction of an unstable spinal segment after tumoral, traumatic, or degenerative disease. Instability in the lumbar spine, is defined as greater than 3 mm of translatory motion and greater than 10 degrees of angulatory motion, as seen on lateral flexion and extension x-rays. The goal of the intervention is to control low back pain commonly present in isthmic or degenerative spondylolisthesis, discogenic back pain, postlaminectomy spondylolisthesis.
The screws are inserted by a posterior way in the pedicle approach zone (the convergence of the lateral aspect of lamina, the caudal aspect of the superior articular facet, and the medial aspect of the transverse process) by exposing the cancellous bone of the pedicle with a rongeur. The length and diameter of the screws are chosen preoperatively from a lumbar CT scan. The screws are fixed to 2 rods. Distraction, compression, bending, rotational correction, and transverse loading of the spine can be performed. The patient is discharged, generally, within 2 to 4 days after surgery. There is a strict follow-up for the first year and then the patient is seen after 2 years. The outcome is better for younger patients and worse for patients with failed back surgery syndrome.
The screws are inserted by a posterior way in the pedicle approach zone (the convergence of the lateral aspect of lamina, the caudal aspect of the superior articular facet, and the medial aspect of the transverse process) by exposing the cancellous bone of the pedicle with a rongeur. The length and diameter of the screws are chosen preoperatively from a lumbar CT scan. The screws are fixed to 2 rods. Distraction, compression, bending, rotational correction, and transverse loading of the spine can be performed. The patient is discharged, generally, within 2 to 4 days after surgery. There is a strict follow-up for the first year and then the patient is seen after 2 years. The outcome is better for younger patients and worse for patients with failed back surgery syndrome.
References
- Abla A, El Kadi H, Wert M et al. Post-Laminectomy Spondylolisthesis: Surgical techniques. Contemporary Neurosurgery 24 : December 2004.
- Hadjipanayis CG, Abla A, Maroon JC et al. Pedicle Screw Fixation of the Lumbar Spine Involving the Sacrum. Contemporary Neurosurgery 7: April 2003.
