Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

Abstract

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or transfacet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine.

Correlation Between Quality of Life and Osteolysis Around Lumbar Pedicle Screws

“…It affects 5% to 8% of the general population, and is reported by 19% of the economically active population, generating costs of more than a hundred billion dollars each year. 1,2 There is a wide spectrum of treatments available for patients with chronic low back pain resulting from degenerative changes to the vertebral spine, including conservative and surgical alternatives. 2 Low back pain and lumbociatalgia are commonly the result of disc disease, which may manifest as intersomatic arthrosis, protrusion and disc extrusion.…”

“…1,2 There is a wide spectrum of treatments available for patients with chronic low back pain resulting from degenerative changes to the vertebral spine, including conservative and surgical alternatives. 2 Low back pain and lumbociatalgia are commonly the result of disc disease, which may manifest as intersomatic arthrosis, protrusion and disc extrusion. The degenerative cascade, associated with lesions of the anatomical structures, vertebral instability and narrowing of the canal and intervertebral foramina, generates an environment that could lead to low back pain and radiculopathies.…”

“…The degenerative cascade, associated with lesions of the anatomical structures, vertebral instability and narrowing of the canal and intervertebral foramina, generates an environment that could lead to low back pain and radiculopathies. 2,3 Lumbar arthrodesis has been indicated as one of the treatment alternatives in selected cases of degenerative diseases of the vertebral spine with instability, including scoliosis, spondylolisthesis, and narrowing of the lumbar canal, 2,3 proving efficient, when properly indicated, and resulting in an improvement in the pain and other disabilities generated by these pathologies. [1][2][3][4] Lumbar arthrodeses can be performed via the anterior, posterior, or posterolateral approaches, or a combination of these.…”

“…2,3 Lumbar arthrodesis has been indicated as one of the treatment alternatives in selected cases of degenerative diseases of the vertebral spine with instability, including scoliosis, spondylolisthesis, and narrowing of the lumbar canal, 2,3 proving efficient, when properly indicated, and resulting in an improvement in the pain and other disabilities generated by these pathologies. [1][2][3][4] Lumbar arthrodeses can be performed via the anterior, posterior, or posterolateral approaches, or a combination of these. The benefits of the posterolateral approach include its relative ease of execution and the fact that most surgeons are familiar with it, the possibility of direct decompression of the neural elements, and the high fusion rates, which are optimized with the use of pedicle instrumentation, increasing the rigidity of the system.…”

Intervertebral Disc Changes after Vertebral Distraction Performed During Posterolateral Spine Fusion for Lumbar Segmental Instability

“…Most of the surgical procedures aim to use spine fusion to mend the pain caused by disc degeneration after sacrificing the intervertebral discs. Many techniques and procedures were developed to attain spine fusion, in most cases; however, the actual surgical approach is determined by the surgeon's experience and opinion [13,14].…”