{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:33:59Z","timestamp":1777494839444,"version":"3.51.4"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,7]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> Of concern to spine surgeons are accelerated degenerative changes of motion segments located above and below where spinal fusion has been performed. Graf artificial ligament stabilization has been developed to avoid the adverse effect of spinal fusion. The object of this study was to assess the adjacent-segment morbidity of Graf ligamentoplasty compared with posterolateral fusion (PF) in which instrumentation was used.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> Data obtained in 45 patients who underwent L4\u20135 Graf ligamentoplasty (18 patients) or PF with instrumentation (27 patients) were reviewed retrospectively. The minimum follow-up period was 5 years. In the PF group a solid fusion rate of 92.6% was achieved. Radiographic evaluation included assessment of lumbar sagittal alignment, range of motion (ROM), and adjacent-disc degeneration. Adjacent-segment morbidity was clinically assessed by determining the reoperation rate.<\/jats:p>\n<jats:p content-type=\"fine-print\">Graf ligamentoplasty maintained regional lordosis and flexibility (13\u00b0 in L4\u20135 lordosis; 4.4\u00b0 in L4\u20135 ROM). Although there was no difference in preoperative adjacent-disc condition between the two groups, radiographic evidence of adjacent-disc deterioration was observed more frequently in patients in the PF group than the Graf group (25% and 6% at L1\u20132; 38% and 6% at L2\u20133; 38% and 18% at L3\u20134; and 43% and 18% at L5\u2014sacrum, respectively). One case in the Graf group (5.6%) and five cases in the PF group (18.5%) required additional surgeries for adjacent-segment lesions.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> Graf ligamentoplasty cannot completely replace spinal fusion. In a well-selected group of patients, however, it was shown to maintain lumbar mobility and sagittal alignment, and it decreased the risk of adjacent-segment deterioration compared with PF with instrumentation.<\/jats:p>","DOI":"10.3171\/spi.2001.95.1.0005","type":"journal-article","created":{"date-parts":[[2009,5,7]],"date-time":"2009-05-07T15:53:32Z","timestamp":1241711612000},"page":"5-10","source":"Crossref","is-referenced-by-count":13,"title":["Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion"],"prefix":"10.3171","volume":"95","author":[{"given":"Masahiro","family":"Kanayama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Shigenobu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahito","family":"Harada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiro","family":"Oha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasumitsu","family":"Ohkoshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Tada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Yamane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Spinal Disord","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1097\/00002517-199306060-00001","article-title":"The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis.","volume":"6","author":"Bridwell","year":"1993"},{"key":"b2","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2655","DOI":"10.1097\/00007632-199711150-00014","article-title":"The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis.","volume":"22","author":"Cunningham","year":"1997"},{"key":"b3","series-title":"Lumbosacral and Spinopelvic Fixation.","first-page":"889","article-title":"An alternative concept in the surgical management of lumbar degenerative disc disease- flexible stabilization","author":"Gardner","year":"1992"},{"key":"b4","series-title":"Spine","first-page":"273","article-title":"The graf ligamentoplasty procedure. 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