Lumbosacral and Spondylo-Pelvic Arthrodesis an Alternative Concept in the Surgical Management of Lumbar Degenerative Disc Disease: Flexible Stabilisation

Effect of surgical treatment on physical activity and bone resorption in patients with neurogenic intermittent claudication

“…1,10,17,24 However, the Graf stabilization system, which was developed to provide stabilization without fusion, may have some advantages over posterolateral fusion, from the following points of view: (a) the Graf stabilization appears to be more physiological, allowing some movement to return to the stabilized motion segment, and this is likely to encourage better neuromuscular activity and reduce stress on adjacent discs; (b) the Graf stabilization takes substantially less time than an instrumented posterolateral fusion, and therefore it is less invasive, with more rapid recovery of lumbar muscle function; and (c) there is no risk of pseudoarthrosis and donor site pain. 5 Biomechanical studies have also demonstrated lumbar instability after laminectomy, and have shown the positive effects of Graf stabilization in restoring lumbar lordosis and increasing segmental stiffness. 20,26 These lines of evidence support the usage of the Graf stabilization system instead of posterolateral fusion.…”

“…The possible modes of action of Graf stabilization are: (a) immobilization in extension providing stability through coaptation of the facet joints; (b) alteration of annular and endplate load bearing; (c) posterior annular compression, resulting in the closure of annular tears and the elimination of neoinnervation and neovascularization; (d) splinting of the motion segment to allow healing of damaged tissues; and (e) band relaxation over the first 4 to 6 months, allowing some return to movement. 5 Therefore, degenerative disc disease with lumbar instability syndrome, which may be defined as a state of mainly chronic low back pain with episodes of acute exacerbation or muscle spasm (or both) on certain movements, not caused by radicular pain, is considered to be the prime indication for Graf stabilization. 5 Furthermore, increasing or maintaining segmental lordosis by Graf stabilization has been suggested to lead to a locking of the facet joints, with the result that the painful stimuli on the nociceptive receptors in the facet joint capsules are reduced and the pain originating from the posterior structures of the lumbar spine, as well as pseudoradicular pain, is abolished.…”

“…5 Therefore, degenerative disc disease with lumbar instability syndrome, which may be defined as a state of mainly chronic low back pain with episodes of acute exacerbation or muscle spasm (or both) on certain movements, not caused by radicular pain, is considered to be the prime indication for Graf stabilization. 5 Furthermore, increasing or maintaining segmental lordosis by Graf stabilization has been suggested to lead to a locking of the facet joints, with the result that the painful stimuli on the nociceptive receptors in the facet joint capsules are reduced and the pain originating from the posterior structures of the lumbar spine, as well as pseudoradicular pain, is abolished. 2 Graf stabilization significantly reduced the slip angle and stabilized the lumbar spine, maintaining regional lumbar lordosis in DLSL in the present study.…”

Graf ligamentoplasty: a 7-year follow-up

“…Lessons were learnt. All these matters are reviewed in greater detail in other publications [2,3,4].…”

Pedicle screw‐based posterior dynamic stabilizers for degenerative spine: In vitro biomechanical testing and clinical outcomes

“…Pedicle screw based PDS devices were developed to overcome some of the morbidities associated with fusion procedures. There are various conceptual advantages of using PDS devices over fusion implants: (1) they obviate the need for autograft, decreasing the potential incidence of disease transmission using allograft or synthetic bone graft materials; (2) higher likelihood of preserving musculature during implantation of a PDS implant, leading to faster recovery times; (3) if the implant fails to achieve desired levels of efficacy, it is relatively easy to replace the motion sparing part with the fusion construct between the pedicle screws; (4) shorter operation time and less blood loss; and (5) surgeon's familiarity in placing pedicle screws . Pedicle screw based dynamic stabilization to address instability requires a two‐fold approach: one is to mimic the kinematic signature of a healthy spine, and other is to restore normal load sharing amongst spinal elements.…”