Abstract:

BACKGROUND: It remains controversial about the source and shape of bone material, as well as the pattern of bone-grafting. As a new method, autogenous morselized bone graft impaction has some advantages, but there are few reports about the clinical application in lumbar interbody fusion.
OBJECTIVE: To investigate the feasibility of pedicle screw fixation with autogenous morselized bone graft impaction in the posterior lumbar interbody fusion for senile lumbar degeneration.
METHODS: A total of 21 senile lumbar degeneration cases (28 segments) underwent autogenous morselized bone graft impaction in the posterior lumbar interbody fusion, including 7 of lumbar disc herniation combined with segmental instability, 6 of lumbar spinal stenosis, and 8 of degenerative lumbar instability. Pedicle screw fixation with autogenous morselized bone graft impaction was performed in all patients. The fusion rate was evaluated according to the pre and post operative X-ray. The clinical outcomes were measured according to VAS scores, ODI scores as well as Macnab evaluation scale.
RESULTS AND CONCLUSION: All patients were followed up for more than 12 months. The bony fusions were detected in 3-5 months postoperatively. No reduction or fixation failure was found. After operation, the lower back pain and leg pain was relieved in different levels. The VAS and ODI scores at the final follow up were significantly improved compared with preoperative scores (P < 0.01), and the fusion rate was 95%. There was 1 case whose CT scanning showed some morselized bone in the spinal canal on day 6 after operation, causing the nerve compressed, and 1 case whose soft tissue of the cut was infected post-discharge on day 5 after operation. The Macnab criteria revealed that 10 patients had excellent result, 9 had good, 0 had fair, and 2 had bad, with a excellent and good rate of 91%. Results show a good short-term clinical outcome of pedicle screw fixation with autogenous morselized bone graft impaction applying in posterior lumbar interbody fusion for senile lumbar degeneration with high interbody fusion rate and low complication rate.