Clinical Investigation of Anterior Vertebral Body Fusion (L4-5) and Anterior Discectomy with out Fusion (L5-S) for the Lowest Double Disc Lesion.

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Selection of the operative procedure for treating multiple disc lesions is often difficult. We adopted anterior vertebral fusion (AVF) for the lowest double disc lesions, particularly for manual workers under 30 years of age. In these cases, over a period of 10 years after surgery stenosis of the canal at the L3-4 level has rarely been found although incomplate union of the L5/S disc space has sometimes been reported. In additoin, in cases of AVF for L4-5 disc lesions with L5-S disc degeneration, herniation of the L5-S has rarely occurred. These results meat that since 1986 we have carried out AVF for L4-5 and anterior discectomy without fusion for L5-S. We clinically evaluated 36 cases all with a post-operative follow-up of at ledst 12 months.Results are as follows:(1) Radiological Findings:1) Narrowing of L5-S disc space and posterior displacement of L5 were found relatively early after surgery2) The range of motion in L5-S disc space tended to decrease after 2 years post-operatively, but its ROM was greater than other disc spaces.(2) Clinical findings:1) Clinical improcement was noted shortly after operation.2) Improvement in ADL, as evidenced by improvement in the range of movement and the ability to life heavy things, was mostly found withinl-2 years after operation.
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