[Stabilization of the lumbosacral segment by distracting posterolateral spondylodesis using the Zielke divided sacral strut. Analysis of 400 cases based on indications, results and cause of errors].

Out of 400 patients who underwent posterolateral or purely dorsal spondylodesis of the lumbosacral joint with a divided sacral strut or sacral knee using distracting Harrington struts, a total of 68.5% were free of complaints--100% in cases of fractures and destruction, spondylarthroses and osteochrondroses, 73% in cases of spondylolyses with and without spondylolistheses, and only 49% among the so-called "failed-back" patients who had already undergone one or more previous operations. Where results were poor, particularly in the group of failed-back patients, when surgical error, pseudarthroses, or inadequacies of instruments were ruled out, it could be assumed in approximately 80% of the cases that these patients simultaneously had a pension claim under review or had attempted to institute proceedings at a social insurance tribunal. In such cases the goal of treatment desired by the surgeon, i.e., pain-free stability, cannot be the aim of the patients. Freedom from pain means ability to work, and loss of the pension or the pension litigation. It is almost endemic among these patients to put the blame on the same exogenous mechanisms, as far as both time and cause are concerned, in order to obtain certification of their inability to work. The suspicion that they use the operation to prove the severity of their disability is in many cases justified. The high incidence of psychosocial problems is at least a partial explanation of why the measures we took in our efforts to improve the results of surgery failed. We changed the position of the patient, extended the duration of hospitalization, revised our implantation method, verified plasters and braces. To no avail. Essentially, the result of surgery was influenced by four factors: the number of previous operations, drug and alcohol abuse, pseudarthrosis, and simultaneous pension claims. In 1983 and 1984 the number of patients without pain soared. Basically, this is probably due to the fact that in the light of the results of this investigation, more stringent criteria were applied with regard to the selection of patients. If the patient has a claim against a social insurance institution, a private insurer, or physicians who have treated him/her previously (!!!) we refuse to operate. It is unlikely that these patients will be pain-free before the proceedings in question are terminated. This much we have learned from this analysis.(ABSTRACT TRUNCATED AT 400 WORDS)