Surgical treatment of spinal instability: a clinical analysis of 196 cases

Fixation of the spine, consisting in surgical stiffening of vertebrae at various levels, was performed in 196 cases during the period 1995-1999 in the Department and Clinic of Neurosurgery at the Karol Marcinkowski University of Medical Sciences in Poznań. In all these cases there was damage to nerve structures, spinal cord and/or nerve roots, accompanied by spinal instability, resulting mainly from injuries (144 cases), less frequently from neoplastic diseases (24 cases), degenerative diseases (21 cases), or other causes (7 cases). There were 154 males and 42 females ranging in age from to 69 years (mean age 37,82 +/- 15,10). The Frankel scale was applied to assess the severity of spinal coed disorder: we rated 109 cases to levels A, B and C, while 87 cases were rated at levels D and E. The anterior approach to the spine was used in 110 cases, the posterolateral approach in 51 cases, and the posterior approach in 35 cases.
Internal fixation of the cervical spine was performed in 110 cases using cervical plates, body cages, and clamps. In 86 cases of spinal instability in the thoracic and lumboscaral region fixation was performed with intrapedicular screws, intralaminar hooks, and "Z" plates. In addition, autogenic bone grafts (141 cases) and acrylic bone cement (27 cases) were used to achieve spinal stability.
Excellent and good outcomes were achieved in 180 cases. Signs of neurological deficiency were intensified in 13 patients and appeared temporarily in 10 cases. Spinal surgery was repeated in 5 cases because of implant failure. Mortality amounted to 3% (6 cases).