Treatment of Degenerative Disc Disease and Degenerative Spondylolisthesis of the Lumbar Spine - Illustrations

SRS CORE CURRICULUM

A. ''In situ'' posterolateral fusion In situ fusion utilizing autogenous bone graft used to be the ''gold standard'' but with newer implants and techniques it should probably be reserved for older patients requiring spinal fusion or for younger patients with narrowed stable discs (1,3,15,17,24).

B. Posterolateral Fusion/Instrumentation Pedicle screw fixation has been shown to improve fusion rates.
(1,3,26,30,31) Instrumentation also provides for more rapid pain relief and rehabilitation and often obviates the need for orthosis. Most patients undergoing fusion for segmental instability should have instrumentation as part of their fusion procedure.

C. Anterior lnterbody Fusion with Threaded Cage/Bone Dowel This fusion technique is primarily limited to patients with primarily low back pain with degenerative disc disease with narrowed discs without significant osteoporosis (16,20) This technique relies on ligamentotaxis and should be limited to one level. In males impotence continues to be a potential complication from this approach. Figure 2 (A– E) represents pre and postoperative radiographs of a patient with a narrowed degenerative disc at L3–4 with discogenic back pain who underwent an anterior L3–4 internode fusion with a threaded bone dowel.

Figure 2a	Figure 2b
Figure 2c
Figure 2d	Figure 2e