| Purpose(1)To explore the difference in range of motion among MFF,posteriorlateral fusion(PLF)and PLIF techniques on degenerative single segmental lumbal spinal by a finite element method.(2)To evaluate the efficacy and safety of modified facet joint fusion technique(MFF),a retrospective clinical studies was were conducted.(3)To compare fusion rate and clinical outcomes between MFF technique and posterior lumbar interbody fusion(PLIF)for degenerative spondylolisthesis.(4)To compare fusion rate between autologous local bone and allograft bone in the same patient with degenerative lumbar spinal disease underwent instrumented MFF technique.Methods(1)A finite element model of L3～S1 segments with a single segmental degeneration at L4-5 level was established.Different models of L4-5 segmental fusion after MFF,PLF and PLIF techniuqes were established,respectively.Physical loads were applied to the models and the changes of range of motion at L4-5 level in different models were recorded during flexion,extension,lateral bending and rotation.(2)491 consecutive patients with 931 segments who underwent MFF with pedicle screw instrumentation for lumbar degenerative diseases were retrospectively reviewed after 1-year follow-up.Computed tomography with fine-cut axial images and sagittal reconstruction views was used to evaluate the fusion rate of MFF at 6-,12-month follow-up postoperatively.Clinical outcomes included visual analogue scale pain scores for low back pain(VAS-LBP)and leg pain(VAS-LP),Japanese Orthopedic Association scores(JOA),and Oswestry Disability Index(ODI),all of which were obtained preoperatively and postoperative subsequently at 1-,3-,6-,12-month follow-up after surgery.The clinical outcomes were determined to be excellent,good,fair,or poor according to the MacNab classification at the last follow-up time.(3)A single-center retrospective study including patients with grade I or II degenerative spondylolisthesis managed by MFF or PLIF with pedicle screw instrumentation was conducted.Computed tomography with fine-cut axial images and sagittal reconstruction views was used to evaluate the fusion rate at 6-,12-month follow-up postoperatively.Clinical outcomes included VAS-LBP,VAS-LP,JOA and ODI,all of which were obtained preoperatively and postoperative subsequently at1-,3-,6-,12-month follow-up after surgery.The clinical outcomes were determined to be excellent,good,fair,or poor according to the MacNab classification at the 1-year follow-up time.The blood loss,length of incision,operative time,length of hospital stay and overall hospitalization costs were also compared between the two groups.(4)Patients with degenerative lumbar spinal disease and underwent instrumented MFF were enrolled in our prospective randomized controlled study.Allograft bone was randomized to be used for MFF on one side of the facet joints as the Allograft group,then autologous local bone was used on the other side as the control group in the same patient.Computed tomography with fine-cut axial images and sagittal reconstruction views was performed to evaluate the fusion rate between two groups at 6-,12-month follow-up postoperatively.Fusion status was evaluated separately by two radiologists blinded to the group affiliation.The complications and reoperations throughout the follow-up period were also compared.Results(1)As compared to preoperative model,different models of L4-5 segmental fusion after MFF,PLF and PLIF techniques all obtained reliable stability.No difference in range of motion at L4-5 level was observed among the three fusion techniques.(2)Of the 491 patients,the fusion rates at 6-month follow-up were 56.8%(279/491)and 96.1%(472/491)at the 1-year follow-up.Between baseline and 1-year follow-up time,VAS-LP and VAS-LBP improved from 5.6 ± 0.9 to 0.4 ± 0.5 and 5.1 ± 1.2 to 1.5 ± 0.9,respectively.JOA improved from 9.0 ± 2.0 preoperatively to 27.7 ± 1.0 at the 1-year follow-up and ODI decreased from 64.0 ± 2.0 to 19 ± 1 ·0.At the final evaluation,460(93.6%)patients showed excellent or good results,16(3.2%)fair,and 15(3%)poor.There were no MFF technique-related complications.(3)One hundred and thirty-six patients were included in the study(MFF,n = 71;PLIF,n = 65).Fusion rates at the 6-month and 12-month follow-up time were not statistically significant between the MFF and PLIF groups(54.9%vs 58.5%,P =0.67 and 94.4%vs 98.5%,P = 0.20).Clinical outcomes including VAS scores,JOA and ODI showed significant improvement compared with preoperative baseline throughout all follow-up time points and no significant difference between two groups.No complications directly related to the fusion techniques and reoperation occurred.(4)A total of 65 patients were enrolled in this trial.Among them,61 patients with 226 fact joints completed the 1-year follow-up(Allograft group,n = 113;Control group,n = 113).The 1-year follow-up rate was 93.8%.At the 6-month follow-up,fusion rate in control group was higher than Allograft group(51.3%vs 35.4%,P = 0.016).At the 12-month follow-up,fusion rate between two groups has no significant difference(93.8%vs 91.2%,P>0.05).No complications attributable to allograft bone and reoperation occurred.Conclusions(1)MFF technique could achieve comparable spinal stability with PLF and PLIF techniques.(2)MFF with pedicle screw instrumentation achieved satisfactory clinical outcomes and fusion rate.(3)MFF provided fusion rate and clinical outcomes comparable to those of PLIF,which appears to be a promising alternative fusion technique for the treatment of lumbar degenerative diseases.(4)Allograft bone provided comparable fusion rate with autologous local bone as a fusion material for lumbar modified facet joint fusion technique,and could be a notable alternative. |
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