Abstract
Lumbar spine fusion has increasingly been used as a lumbar pain treatment. Its frequency is of 0.03 to 0.6% fusions in the population over 65 years of age. The first factor of this increase is the use of more accurate non-invasive diagnostic mediums as CAT or MRI.
The second increasing factor has been the pedicular fixation introduced by Roy-Camille. Recently the use of interbody cages has made easier the correction of disc collapse, instability and sagital deviations. Both posterior and anterior fixation is used with different sort of approaches, according to the particular patient or training of the surgeon. The systematic use of fluoroscopy and navigational devices rends accurate the use of internal fixation. The third factor increasing the frequency of spinal fusion is the raising demography of well-trained spinal surgeons’ perhaps one of the most influential reasons of the higher success rates.
Notwithstanding those advances, it remains a number of failures. The rate of reoperations after fusion has been assessed to be 17.4% over 4 postoperative years. The advances in the knowledge of cellular signals and factors of ossification can diminish the failed bone fusions. The use of different sorts of bone-grafts, bone-substitutes and bone enhancers has rendered easier the postoperative regimes. The rhBMP’ use with specific carriers as sole fusion initiator has been successfully introduced and inhibitors of bone growth as nicotine or NSAIDs identified.
But the same factors of control of vertebral motion are the cause of errors than can be the origin of root lesions. The bulky hardware is a co-operative factor in the onset of septic failures. And the surgeon’s demography origins a higher number of borderline indications.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
