The Treatment of Ruptured Lumbar Intervertebral Discs by Vertebral Body Fusion

I. Indications, Operative Technique, After Care

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Whenever the subject of the treatment of ruptured lumbar intervertebral discs is discussed, one always finds controversy and disagreement among neurosurgeons and orthopedic surgeons on the advisability, indication and necessity of a spinal fusion in these cases.2 The reason for this controversy is obviously the fact that many patients who have had operations for the removal of a ruptured intervertebral disc have not been cured of their symptoms or have returned at a later date with a recurrence of them.

Dandy12 stated very positively that spinal fusions were absolutely unnecessary and that one had

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Figures

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    Technique of vertebral body fusion. Note wide exposure of spinal canal by removal of half of articular facets. Upper right drawing shows only gelfoam covering dura mater. The ligamentum flavum is preserved to protect dura mater.

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    (a) Self-retaining dura retractor. The clamp attaches to any laminectomy retractor. (b) The vertebra retractor and (c) vertebra spreader.

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    Removal of ruptured disc in preparation for bone grafting of intervertebral space.

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    X-ray taken 10 days postoperative showing position of 3 full-thickness iliac grafts in intervertebral space, replacing the disc. The silver clip is placed to determine, by x-ray, the anterior extent of the disc removal.

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    X-rays taken 3½ months after surgery. Solid fusion of adjacent vertebral bodies is indicated by lines of trabeculation extending through the intervertebral graft. This patient, a “jack hammer” operator, returned to his job 2½ months after operation.

References

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