CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(02): 140-148
DOI: 10.1016/j.rbo.2017.11.006
Original Article | Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease—Prospective Analysis of Clinical and Functional Outcomes[*]

Article in several languages: português | English
Diogo Lino Moura
1  Serviço de Ortopedia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
2  Spine Institute of Ohio, Grant Medical Center, Columbus, Estados Unidos da América
,
David Lawrence
2  Spine Institute of Ohio, Grant Medical Center, Columbus, Estados Unidos da América
,
Josué Pereira Gabriel
2  Spine Institute of Ohio, Grant Medical Center, Columbus, Estados Unidos da América
› Author Affiliations
Further Information

Publication History

21 October 2017

28 November 2017

Publication Date:
15 April 2019 (online)

Abstract

Objective This was a prospective controlled study with lumbar degenerative disc disease patients submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior stabilization.

Methods A sample with 64 consecutive patients was operated by the same surgeons over 4 years. Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody cages with integrated screws, filled with bone matrix and bone morphogenetic protein 2, were used.

Results Half of the patients had undergone previous lumbar spine surgeries, 75% presented with associated degenerative listhesis, and 62.5% had posterior lumbar compression disease. Approximately 56% of the sample had at least 1 risk factor for nonunion. The Oswestry index changed from 71.81 ± 7.22 at the preoperative assessment to 24.75 ± 7.82 at the final follow-up evaluation, while the visual analogue pain scale changed from 7.88 ± 0.70 to 2.44 ± 0.87 (p < 0.001). Clinical and functional improvements increased with the number of operated levels, proving the efficacy of multilevel ALIF, performed in 93.75% of the sample. The global complication rate was of 7.82%, with no major complications. No cases of nonunion were observed.

Conclusion Instrumented ALIF combined with posterior stabilization is a successful option for uni- and multilevel degenerative disc disease of the L3 to S1 segments, even in the significant presence of risk factors for nonunion and of previous lumbar surgeries, assuring very satisfactory clinical-functional and radiographic outcomes with a low medium-term complication rate.

* Work developed at the Serviço de Ortopedia of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.