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Jacking Up The Spine – A Better Way Of Treating Lumbar Spine Instability

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Author(s): Dr. P Gopinathan

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 2;
Issue: 1;
Date: 2005;
Original page

Keywords: jacking up the spine | lumbar segmental instability

ABSTRACT
Background: The primary concern of LSI is radicular pain and pain due to instability. The reduction in the disk height results in narrowing of the intervertebral foramen and there by produces compression of the emerging root. This can be relieved to a little extent by foraminotomy, but total correction of the real pathological processes could be achieved by increasing the disk height by the method of jacking of the spine so that the size of the intervertebral foramen increases and there is indirect decompression of root. Purpose of the study to understand the clinical outcome regarding the radicular pain by the technique of PLIF with distraction, instrumentation and fusion posterolaterally. Patients And Methods: 21 patients between 2001 and 2004 who had discectemy, PLIF with posterior distraction instrumentation and posterolateral fusion were followed up for an average of 16 months. There were 12 females and 9 males. The clinical and radiological criteria of Lumbar Segmental Instability were defined for inclusion in to the study group. Clinical outcome was assessed VAS and Oswestry score. Radiological assessment of fusion was done as the trabeculae crossing intervertebral space and graft incorporation posteriorly. Observation And Results: 19 patients had single level PLIF, 2 patients had double level PLIF. 14 patients had double segment fusion posteriorly. Functional score was better in all cases but more so in lysis without listhesis. There were no relation between sex and rate of fusion. At 16 months average follow up, 10 patients had graft incorporation posteriorly and 3 patients had trabeculae crossing the intervertebral disk space. Fusion was faster at L5-S1 level. The commonest functional spinal unit affected was L5-S1. Discussion: LSI is a concern both for patients and surgeons, even today. Accurate preoperative identification of each component of the problem which produces a particular symptom should be addressed individually for a complete relief. The instability starts as a sclerosis of the end plates and then proceeds on to the anterior and posterior complexes, finally resulting in global instability, which makes the patient symptomatic. It is the surgeons duty to intervene at any of these stages so that, this cascade of process can be arrested at any stage. Conclusion: Maintaining the disk height by a posterior instrumentation with distraction prevents reduction of the disk height and thereby maintaining the size of intervertebral foramen. This will help in reducing the radicular symptoms.
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