الفهرس | Only 14 pages are availabe for public view |
Abstract Background: Low back pain and sciatica represent a common disabling condition with a significant impact on the social, working and economic lives of common surgical procedure in degenerative spine used in the PLF procedure.Purpose: To compare the results of treatment of degenerative lumbar diseases using rigid or flexible rods clinically and radiologically.Patient sample: Prospective case study of 50 patients with degenerative lumbar disc diseases (disc degeneration, and lumbar stenosis) with follows up 12 months at least. Outcome measures: Patients were evaluated by the Visual Analogical Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI) preoperatively and postoperatively 1, 3, 6, 12 months. The radiological evaluation followed the bone trabecular bridging scale depending on X-ray and CT on 6 – 12 months when indicated (to confirm fusion). Methods: It consisted of a prospectively collected randomised of 50 patients with degenerative lumbar disc diseases who met inclusion criteria treated between February 2019 and February 2020. They were selected for instrumented posterolaterl Fusion (PLF) technique using Titanium flexible (group1) rods in 25 patients, the other 25 titanium rigid (group2) rods with autologous bone graft in shark el madina hospital, Alexandria and Kasr El Einy Hospital,, Cairo, Egypt. The group 1 included 13 males and 12 females with youngest patient in this study was 32 years old and the eldest patient was 65 years old.Group2 included 13 males and 12 females with youngest patient was 28 years old and eldest was65 years old. Pre-operative assessment: History taking, clinical examination and radiological assessment (Plain X-Ray, MRI). Results: Mean Back pain VAS improved from 5.68±0.63 preoperatively to 2.28±0.61(1)at 3months, 1.44±0.51at 12 months in group(1) ,while in group (2) VAS improved from, 5.64 ± 0.49 preoperatively to2.36 ±0.76 at 3months ,1.48±0.51 at 12 months follow up. Mean VAS (leg) improved from 6.64±1.29 SD preoperatively to , 1.92± 0.57 SD at 6 months and 1.28 ±0.61 SD at 12 months in group (1). While in group(2), mean VAS (leg) improved from 6.52 ±1.19 SD preoperatively to 6 months and 1.28± 0.61 SD at 12 months .Mean ODI improved from 56.16 ±8.56 SD preoperatively to 26.44 ±4.95 SD at 6 months and 20.16 ±3.72 SD at 12 months in group (1). While in group(2) ,mean ODI improved from 59.52 ±6.37 SD preoperatively to 27.32 ±4.26 SD at 6 months, and 21.08 ±3.37 SD at 12 months in group (2).There were no significant differences between the postoperative ODI in comparison between the two groups. Fusion rates were 15 of 25 cases (60%) at 6 months in group 1 while only 11 cases fused in first 6 months in group 2(56%) and 22 of 25 cases (88%) by 12 months and 8 cases were fused within 6 months(80%)in group 2,while20 cases were fused by the end of 12 months. In group (1) there was 4 cases (16%) of wound infection . Two of our patients (5%) had intra-operative dural tear. In group (2) there was 2(8%) of our cases reported infection, and only one patient had mechanical failure Conclusions: There is no difference between flexible and rigid rods in clinical outcomes with more rate of fusion with using flexible rods |