Graf ligamentoplasty: a 7-year follow-up

Graf ligamentoplasty is seen as a means of stabilising and reducing the mobility of one or more severely symptomatic motion segments associated with degenerative disc disease. It is a less invasive procedure than fusion and appears to have a similar or slightly better success rate. Some studies have reported mixed results at early follow up; generally, they have suffered from poorly defined indications for the procedure, which are now much clearer. Reports on the first 50 patients undergoing Graf stabilisation in 1990/1991 were published in the European Spine Journal in 1995, with a 2-year follow-up. In the present study, the results of which were independently reviewed by the second author (K.C.P.), a spinal research fellow from an unrelated centre, we were able to establish postal contact with 40 of those patients, of whom 31 still had Graf instrumentation in situ. Examination of the clinical records of the ten non-responders when last seen indicated no particular bias of the results. The average age at surgery and average follow-up were 41.8 years (range 17.2-60 years) and 7.4 years (range 5.6-8.5 years) respectively. Excellent and good subjective results were reported in 62% of patients; 61% reported significant or total relief of low-back pain and 77% never or occasionally used analgesics. Patients were evaluated using the Oswestry Disability Score and the MSPQ (Modified Somatic Perception Questionnaire) and Zung Depression Index with the DRAM (Disability and Risk Assessment Method). Additional information was obtained from the clinical notes and radiographs at last review. The mean Oswestry Disability Score was 59+/-10% pre-operatively and 37.7+/-14% after 7 years. There was a statistically significant correlation between the Oswestry scores and the subjective outcome (P=0.009). The results of this study suggest that the beneficial effects of Graf ligamentoplasty are sustained in the longer term in spite of the presence of an established degenerative process.