Abstract
Introduction
In the surgical treatment of degenerative disc disease, specifically in L5/S1 segment have been proposed various treatment modalities, the most used is posterior arthrodesis considered nowadays as the current gold standard.
Objective
This study aims to compare the results of two groups of patients with degenerative disc disease in terms of improvement in pain, functional scale, functional recovery time, and radiological lumbar lordosis correction.
Material and Methods
Two groups of patients diagnosed with degenerative disc disease (adult patients, chronic low back pain of more than 6 months duration, with failed previous treatment without radicular component, decreased height of intervertebral space, studies were compared retrospectively with plain X-ray, CT and MRI), operated from April 2009 to April 2014, with a minimum follow-up of 6 months and maximum of 4 years. A group of 25 patients was treated with arthrodesis using a posterior approach with fixation with pedicle screws and bone graft posterolateral from bone bank, while the second group of 22 patients was treated with technique ALIF with PEEK cage via anterior approach (standalone), with fixing screws to the platforms and bone grafting from bone bank. Pain and Oswestry functional index plus functional recovery time and return to work, as well as changes in radiological lumbar lordosis were compared. Operative time, bleeding, and hospitalization time were also compared. Statistics included measures of central tendency, and standard deviation for continuous variables, and frequencies and proportions for categorical variables were used. Student t-test was used to compare both groups to perform simultaneous and multivariate analysis clinical measures.
Results
We found improvement on the pain intensity visual analog scale, at least 50% of the intensity of initial pain, and in regard to functional scale (p > 0.01), it was possible to improve the overall height of the intervertebral space the anterior approach which was not achieved by the posterior route. Moreover, significant differences of less surgical time, less bleeding, shorter hospital stay, and were found by the anterior approach to the posterior approach.
Conclusion
In this study was found for degenerative disc disease of L5/S1, a better surgical outcome by the anterior approach than the posterior approach in terms of pain and functional recovery in an average follow-up of 2 years.