Graf ligamentoplasty: a 7-year follow-up

Gardner, Alan; Pande, Ketan C

doi:10.1007/978-3-642-18508-3_16

Cited by 22 publications

(28 citation statements)

References 6 publications

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“…They cautioned against the continued use of this method. More recently, Gardner and Pande [4] reported a 62% rate of "excellent" or "good" subjective results in 31 patients after a mean follow-up of 7.4 years.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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“…To avoid adjacent disc hyper-mobility and the possible resulting progression of degeneration, dynamic implants have been developed [10,18,32,33]. Therapeutic strategy of these implants is stabilization by reducing loads while allowing motion in the treated segment.…”

Section: Introductionmentioning

confidence: 99%

Dynamic stabilization adjacent to single-level fusion: Part I. Biomechanical effects on lumbar spinal motion

et al. 2010

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Progression of superior adjacent segment degeneration (PASD) could possibly be avoided by dynamic stabilization of an initially degenerated adjacent segment (AS). The current study evaluates ex vivo the biomechanics of a circumferential fixation connected to posterior dynamic stabilization at the AS. 6 human cadaver spines (L2-S1) were stabilized stepwise through the following conditions for comparison: intact spine (ISP), single-level fixation L5-S1 (SLF), SLF ? dynamic AS fixation L4-L5 (DFT), and two-level fixation L4-S1 (TLF). For each condition, the moments required to reach the range of motion (ROM) of the intact whole spine segment under ±10 Nm (WSP10) were compared for all major planes of motion within L2-S1. The ROM at segments L2/3, L3/4, and L4/5 when WSP10 was applied were also compared for each condition. The moments needed to maintain WSP10 increased with each stage of stabilization, from ISP to SLF to DFT to TLF (p \ 0.001), in all planes of motion within L2-S1. The ROM increased in the same order at L3/4 (extension, flexion, and lateral bending) and L2/3 (all except right axial rotation, left lateral bending) during WSP10 application with 300 N axial preload (p \ 0.005 in ANOVA). At L4/5, while applying WSP10, all planes of motion were affected by stepwise stabilization (p \ 0.001): ROM increased from ISP to SLF and decreased from SLF to DFT to TLF (partially p \ 0.05). The moments required to reach WSP10 increase dependent on the number of fixated levels and the fixation stiffness of the implants used. Additional fixation shifts motion to the superior segment, according to fixation stiffness. Therefore, dynamic instrumentation cannot be recommended if prevention of hyper-mobility in the adjacent levels is the main target.

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“…Ligamentoplasty appears to be an alternative to decompression with spondylodesis. To obviate the post-fusion adjacent level degenerative changes in the spine and perceived spinal instability as a result of extensive laminectomy, nonfusion technologies are being explored and analyzed 636–41. Graf artificial ligament stabilization is one such technique.…”

Section: Discussionmentioning

confidence: 99%

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

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Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

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Graf ligamentoplasty: a 7-year follow-up

Cited by 22 publications

References 6 publications

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

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

Dynamic stabilization adjacent to single-level fusion: Part I. Biomechanical effects on lumbar spinal motion

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

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