Dynamic Stabilization of Lumbar Motion Segments by Use of Graf's Ligaments: Results with an Average Follow-up of 7.4 Years in 39 Highly Selected, Consecutive Patients

Background: In recent years considerable effort was undertaken in order to replace rigid lumbar stabilization by soft stabilization in certain instances. The Graf soft system stabilization technique is such an interesting novel alternative to lumbar arthrodesis in the treatment of mechanical low-back disorders. The current retrospective analysis reports the long-term results in 39 consecutive patients treated with Graf's ligaments for painful lumbar instability.

Methods: Young patients with lumbar mechanical disorders resistant to conservative treatment with 1) no or mild facet joint degeneration, 2) minor disc degeneration, 3) well trained low back muscles, 4) pain relief after trial anaesthesia and 5) probatory rigid plastic jacket underwent lumbar ligamentoplasty according to Graf. The patients were assessed clinically and they filled in an extensive questionnaire at an average period of observation of 7.4 years.

Findings: After 7.4 years the clinical results in 39 patients were excellent, good, fair, unchanged and worse in 43.6%, 20.5%, 10.2%, 23.1% and 2.6%, respectively. Seven unchanged patients were converted to arthrodesis. In the questionnaire 66.6% reported total disappearance of back pain, in 25.7% it was significantly less and in 7.7% back pain was a bit less. Visual analogue scale for low back pain was 0 in 69.2%, 2.5 in 15.4% and 5 in 15.4% of patients. For leg pain it was nil in 92.3% and 2.5 in 7.7%.

Interpretation: Soft system stabilization of lumbar motion segments in young patients with painful mechanical disease resistant to conservative treatment yields favourable long-term results only in a highly selected patient population.