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. 1997 Dec;6(6):412–416. doi: 10.1007/BF01834071

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system

B Dahl 1,✉, P Gehrchen 1, P Blyme 1, T Kiær 1, E Tøndevold 1
PMCID: PMC3467720  PMID: 9455671

Abstract

Several biomechanical studies have evaluated the quality of fusion obtained with a rigid versus a semi-rigid pedicle screw implant. Some studies indicate that increased rigidity of the implant system results in an increased strength of the fusion mass. Other reports have underlined the risk of stress shielding due to rigid implant systems. Based on these findings some authors have recommended the use of a semi-rigid system. There are, however, few studies focusing on any possible difference in clinical outcome between the two different types of implant systems. Questionnaires were sent to 89 patients who had undergone primary spinal fusion with either a rigid or a semi-rigid pedicle-screw-based implant system. In every case the diagnosis was spondylolisthesis or degenerative lumbar disease. The questionnnaires were analysed using forward stepwise logistic regression analysis. Eighty (90%) of the questionnaires were returned. There was a mean follow-up of 4 years (range 2–8 years). It was not possible to demonstrate any difference in clinical outcome between patients undergoing lumbar fusion with a rigid implant system and those given a semi-rigid system. The overall patient satisfaction rate was 69%, with no difference between the two types of implant. No difference in clinical outcome between the two types of implant was found. Considering the fact that the primary goal of spinal fusion procedure is to obtain a solid fusion mass, biomechanical tests favour the used of a rigid pedicle screw system. This fact combined with the fact that early mobilisation is possible with rigid implants justifies the use of rigid implant systems, although no difference in clinical outcome could be demonstrated in this study.

Key words: Outcome, Spinal fusion, Implant, Rigid, Semirigid

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References

  • 1.Ashman RB, Galpin RD, Corin JD, et al. Biomechanical analysis of pedicle screw instrumentation systems in a corporectomy model. Spine. 1989;14:1398–1405. doi: 10.1097/00007632-198912000-00019. [DOI] [PubMed] [Google Scholar]
  • 2.Bloch R. Methodology of clinical back pain trials. Spine. 1987;12:430–432. doi: 10.1097/00007632-198706000-00002. [DOI] [PubMed] [Google Scholar]
  • 3.Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions. Spine. 1993;18:1186–1189. doi: 10.1097/00007632-199307000-00010. [DOI] [PubMed] [Google Scholar]
  • 4.Brodsky AE, Kovalsky ES, Khalil MA. Correlation of radiologic assessment of lumbar spine fusions with surgical exploration. Spine. 1991;16:261–265. doi: 10.1097/00007632-199106001-00017. [DOI] [PubMed] [Google Scholar]
  • 5.Cotrel Y, Dubousset J, Guillauman M. New universal instrumentation in spinal surgery. Clin Orthop. 1988;227:1023. [PubMed] [Google Scholar]
  • 6.Greenough CG, Fraser RD. The effects of compensation on recovery from low-back injury. Spine. 1989;14:947–955. doi: 10.1097/00007632-198909000-00006. [DOI] [PubMed] [Google Scholar]
  • 7.Gurr KG, McAfee PC, Warden KE, et al. Roentgenographic and biomechanical analysis of lumbar fusions: a canine model. J Orthop Res. 1989;7:1216–1222. doi: 10.1002/jor.1100070610. [DOI] [PubMed] [Google Scholar]
  • 8.Horowitch A, Peek RD, Thomas JC, et al. The Wiltse pedicle screw fixation system: early clinical results. Spine. 1989;14:461–467. doi: 10.1097/00007632-198904000-00025. [DOI] [PubMed] [Google Scholar]
  • 9.Johnsson R, Strömqvist B, Axelsson P, et al. Influence of spinal immobilization on consolidation of posterolateral lumbosacral fusion. A roentgen stereophotogrammetric and radio graphic analysis. Spine. 1992;17:16–21. doi: 10.1097/00007632-199201000-00003. [DOI] [PubMed] [Google Scholar]
  • 10.Johnston CE, Ashman RB, Baird AM, et al. Effect of spinal construct stiffness on early fusion mass incorporation. Spine. 1990;15:908–912. doi: 10.1097/00007632-199009000-00013. [DOI] [PubMed] [Google Scholar]
  • 11.Johnston CE, Welch RD, Baker KJ, et al. Effect of spinal construct stiffness on short segment fusion mass incorporation. Spine. 1995;20:2400–2407. doi: 10.1097/00007632-199511001-00006. [DOI] [PubMed] [Google Scholar]
  • 12.Kant AP, Daum WJ, Dean M, et al. Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation. Spine. 1995;20:2313–2317. [PubMed] [Google Scholar]
  • 13.Keller RB, Rudicel SA, Liang MH. Outcomes research in orthopaedics. J Bone Joint Surg [Am] 1993;75:1562–1574. [Google Scholar]
  • 14.Kiviluoto O, Santavira A, Salenius P, et al. Posterolateral spine fusion. A 1–4 year follow-up of 80 consecutive patients. Acta Orthop Scand. 1985;56:152–154. doi: 10.3109/17453678508994343. [DOI] [PubMed] [Google Scholar]
  • 15.Lipscomb HJ, Grubb SA, Talmage RV. Spinal bone density following spinal fusion. Spine. 1989;14:477–479. doi: 10.1097/00007632-198904000-00028. [DOI] [PubMed] [Google Scholar]
  • 16.McAfee PC, Farey ID, Sutterlin CE, et al. Device-related osteoporosis with spinal instrumentation. Spine. 1989;14:9–14. doi: 10.1097/00007632-198909000-00003. [DOI] [PubMed] [Google Scholar]
  • 17.Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–377. [Google Scholar]
  • 18.Nachemson AL. Evaluation of results in lumbar spine surgery. Acta Orthop Scand. 1993;64:130–133. doi: 10.3109/17453679309160143. [DOI] [PubMed] [Google Scholar]
  • 19.O'Beirne J, O'Neill D, Gallagher J, et al. Spinal fusion for back pain: a clinical and radiographical review. J Spinal Disord. 1992;5:32–38. doi: 10.1097/00002517-199203000-00005. [DOI] [PubMed] [Google Scholar]
  • 20.Pearcy M, Burrough S. Assessment of bony union after interbody fusion of the lumbar spine using a biplanar radiographic technique. J Bone Joint Surg [Br] 1982;64:228–232. doi: 10.1302/0301-620X.64B2.7040410. [DOI] [PubMed] [Google Scholar]
  • 21.Pihlajamäki H, Böstman O, Ruuskanen M, et al. Posterolateral lumbosacral fusion with transpedicular fixation. 63 consecutive cases followed for 4 (2–6) years. Acta Orthop Scand. 1996;67:63–68. doi: 10.3109/17453679608995612. [DOI] [PubMed] [Google Scholar]
  • 22.Roy-Camille R, Benazet J, Desauge JP, et al. Lumbosacral fusion with pedicular screw plating instrumentation. A 10-year follow-up. Acta Orthop Scand. 1993;64:100–104. doi: 10.3109/17453679309160135. [DOI] [PubMed] [Google Scholar]
  • 23.Roy-Camille R, Saillant G, Berteaux D, et al. Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol. 1976;15:2–16. [PubMed] [Google Scholar]
  • 24.Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop. 1986;203:7–17. [PubMed] [Google Scholar]
  • 25.Stefee AD, Biscup RS, Sitkowski DJ. Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar thoracolumbar spine. Clin Orthop. 1986;203:45–53. [PubMed] [Google Scholar]
  • 26.Stefee AD, Sitkowski DJ. Reduction and stabilization of grade IV spondylolisthesis. Clin Orthop. 1988;227:82–89. [PubMed] [Google Scholar]
  • 27.Turner JA, Ersek M, Herron L, et al. Patient outcomes after lumbar spinal fusions. JAMA. 1992;268:907–977. [PubMed] [Google Scholar]
  • 28.Zdeblick TA. A prospective, randomized study of lumbar fusion. Spine. 1993;18:983–991. doi: 10.1097/00007632-199306150-00006. [DOI] [PubMed] [Google Scholar]

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