Abstract
1. A relatively simple method of spinal fusion with internal splinting by screw fixation has been described. Complications have been few.
2. Emphasis is placed upon thorough removal of soft tissue, correct placement of screws of good length, the exposure of bleeding bone wherever possible in the fusion area, and the use of well packed cancellous bone.
3. There is enough spongy bone in one posterior superior iliac spine for an ordinary spinal fusion, and, if more is needed, the other is readily available through the same skin incision. Not only is cancellous bone more desirable than a massive cortical graft, but the leg is spared, allowing early walking and freedom from complications in the limb.
4. The lateral articulations are left intact.
5. Screw fixation has eliminated the use of external support except in spondylolisthesis, or when so much bone has been removed during laminectomy that good fixation cannot be obtained.
6. Early, sometimes immediate, relief of symptoms is usual after operation, and early walking with moderate activity is desirable.
7. When the operation was done for degenerative changes with no apparent defect in the laminae there was no radiological evidence of failure of fusion after operations at one level, but two failures were found after attempted fusions at multiple levels.
8. Root irritation from screw contact in two patients was due to faulty technique. A method of screw placement to avoid this complication is described and illustrated by radiographs and photographs of a cadaver specimen.
9. There has been no known instance of an adverse psychological effect from the use of screws. Rather, there has commonly been a lively and healthy interest shown in the factor which has allowed early activity.
