Spinal fusion without instrumentation – Experimental animal study

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BackgroundThe number and cost of instrumented spinal fusion surgeries have increased rapidly, primarily for the treatment of lumbar segmental instabilities. However, what if the organism itself is able to restore segmental stability over time? This large-animal study using sheep aimed to investigate whether the reparative response after destabilization via facetectomy and nucleotomy without instrumentation can effectively fuse the spinal segment comparable to instrumented standard fusion surgery.MethodsThe following four surgical interventions were investigated: dorsal fixation via internal fixator, ventral fixation via cage as well as facetectomy and nucleotomy without additional instrumentation. Six months postoperatively, the animals were sacrificed, and the lumbar spines were used for biomechanical tests.FindingsSpinal stability was restored to the destabilized spinal segments at six months postoperatively and was comparable to the results of conventional surgery via screws and cages. Iatrogenic hypomobilization caused significant reductions in facet joint space and intervertebral disc height of segments at index and adjacent level. Restabilized segments after iatrogenic hypermobilzation also significantly decreased facet joint space and disc height at index level, but revealed no influence on adjacent segments.InterpretationThese findings in the sheep model question the necessity of costly instrumentation and suggest the alternative possibility of stimulating the reparative capacity of the body in human lumbar spine fusion surgery.HighlightsAnimal study on fusion after spinal destabilization with and without instrumentationSpinal stability was restored six months postoperatively without instrumentation.Results were comparable to conventional surgery via screws and cages.Findings challenge the necessity of costly instrumentation.

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