Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation.

Forty-seven patients who had lumbar or lumbosacral fusion with or without pedicle screw internal fixation by one surgeon for treatment of degenerative lumbar disease with clinical instability were retrospectively reviewed by an independent observer. Eighteen of the 21 patients whose fusions were internally fixed with the Variable Spinal Plating (VSP) system were available for review. A control group consisted of 27 patients who had fusion without internal fixation. The rate of pseudarthrosis did not significantly differ between the two groups (VSP group, 22%; versus control group, 26%). Twelve (67%) of the 18 patients treated with fusion and VSP instrumentation were considered to have had a good or excellent outcome, whereas 19 (70%) of the 27 patients treated by fusion without internal fixation had good or excellent results. Two VSP-instrumented patients had postoperative leg dysesthesias, whereas this complication was not observed in the control group. Bilateral posterolateral lumbar or lumbosacral fusion without internal fixation is as effective as and safer than fusion with pedicle screw instrumentation.