Correlation between inter-vertebral disc morphology and the results in patients undergoing Graf ligament stabilisation

Abstract

Background. Previous studies have shown Graf ligament stabilisation procedure to give mixed results in the short to medium term. The aim of this study was to correlate the pre-operative state of the disc, multifidus muscles, age of the patient, levels operated and the clinical outcome after a mean follow-up of 47 months. Methods. Graf ligament stabilisationprocedure was carried out in 38 patients between 1996 and1999. Their post-operative status was assessed using MacNab criteria. The postoperative follow-up was by postal questionnaires and review of the clinical notes. Disc morphology and multifidus muscle wasting was graded blindly and independently. The intra-and interobserver reliability was measured with kappa score and classified using the kappa classification of Landis and Koch. Correlation was measured with the help of Spearman correlation coefficient. Results. Thirty-eight patients (100%)returned the questionnaires. Mean follow-up time was 47.55 months. Fifty-nine levels were operated on. Mean age was 39.68 years. The overall re-operation rate was 15.8%. The intra-and interobserver reliability was graded as good to substantial. Twenty-two patients (57.89%) were satisfied with the procedure. There was no statistically significant correlation between disc morphology, multifidus muscle wasting, sex, age, number of levels operated, the levels operated, and the satisfaction rate.Conclusions. The indications of Graf ligament stabilisation procedure are not clear. Further work is necessary to clearly identify the indication for the procedure.

Painful Disc Lesion: Can Modern Biplanar Magnetic Resonance Imaging Replace Discography?

“…1-4). 12 Additional features recorded were HIZs, end plate changes, and annular tears. The criteria used by Aprill and Bogduk 9 were used to identify HIZ.…”

Cluster Analysis as a Method for Determining Size Ranges for Spinal Implants: Disc Lumbar Replacement Prosthesis Dimensions from Magnetic Resonance Images

“…In a consecutive sequence of patients treated by Global (Graf) ligament stabilization, painful degenerative disc disease of a moderate degree affected L4 -L5 and L5-S1 for 51 out of 58 discs (86%). 17 Also, for 69 patients in a prospective randomized study undergoing 1 or 2 lumbar level spinal fusion, all were fused at L4/5 and/or L5/S1. 24 A review of one surgeon's 275 spinal fusions over a 10-year period showed that 35 had a fusion at L3/4, and the remainder had 1 or 2 level fusions at L4/5 and/or L5/S1 (Gibson et al, unpublished data, 2005).…”

“…The Woodend classification grades discs on a scale of 1-4, where grade 1 is a normal disc with a white nucleus, normal shape, and no anular tears. 17 As a result, 69 patients in the age range of 19 -68 years (mean 38) were available. These patients had 345 lumbar discs, but L1-L2 and L2-L3 did not have transverse images, and so were excluded from the study because lateral measurements could not be made from them.…”

Dynamic Stabilization for Challenging Lumbar Degenerative Diseases of the Spine: A Review of the Literature

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