A Minimum 10-Year Follow-up of Posterior Dynamic Stabilization Using Graf Artificial Ligament

    loading  Checking for direct PDF access through Ovid


Study Design.A retrospective long-term follow-up study.Objectives.To report minimum 10-year follow-up results of posterior dynamic stabilization using Graf artificial ligament and to evaluate the role and limitations of this procedure in the treatment of degenerative lumbar disorders.Summary of Background.Motion-preserving surgeries, including artificial disc replacement and ligamentoplasty, are increasingly gaining interest to avoid adverse effects of spinal fusion, but literature addressing long-term results is sparse.Methods.A total of 56 consecutive patients who underwent Graf ligamentoplasty were reviewed at a minimum 10-year follow-up. Forty-three patients in the original cohort had sufficient clinical and radiographic follow-up for analysis. The pathologies included degenerative spondylolisthesis in 23 patients, disc herniation with flexion instability in 13 patients, spinal stenosis with flexion instability in 4 patients, and degenerative scoliosis in 3 patients. Single-level procedures were performed in 36 patients; multilevel procedures were performed in 7 patients. Radiographic and clinical assessments were performed before surgery and at the final follow-up.Results.Disability due to low back pain and/or sciatic symptoms was significantly improved in the patients with degenerative spondylolisthesis or flexion instability. However, degenerative scoliosis and/or laterolisthesis were associated with poor clinical improvement. In radiographic assessment, segmental lordosis was maintained in 10.9°, and flexion-extension motion was averaged 3.6° at the final follow-up. Facet arthrodesis eventually occurred in 14 patients (32.6%) at an average of 82 months after surgery. Additional surgeries were required in 3 patients (7.0%) for adjacent segment pathologies.Conclusion.The long-term results showed that Graf ligamentoplasty is an effective treatment option for low-grade degenerative spondylolisthesis and flexion instability. However, this procedure has limitations to correct spinal deformity, and is not advocated for the treatment of degenerative scoliosis and laterolisthesis.

    loading  Loading Related Articles