RSS-Feed abonnieren
DOI: 10.1016/j.rbo.2017.11.006
Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease—Prospective Analysis of Clinical and Functional Outcomes[*]
Artikel in mehreren Sprachen: português | EnglishPublikationsverlauf
21. Oktober 2017
28. November 2017
Publikationsdatum:
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.
Keywords
lumbar vertebrae/surgery - spinal fusion - prospective studies - scoliosis/surgery - risk factors* Work developed at the Serviço de Ortopedia of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
-
References
- 1 Phan K, Thayaparan GK, Mobbs RJ. Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion--systematic review and meta-analysis. Br J Neurosurg 2015; 29 (05) 705-711
- 2 Rao PJ, Loganathan A, Yeung V, Mobbs RJ. Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study. Neurosurgery 2015; 76 (01) 7-23
- 3 Burkus JK, Gornet MF, Schuler TC, Kleeman TJ, Zdeblick TA. Six-year outcomes of anterior lumbar interbody arthrodesis with use of interbody fusion cages and recombinant human bone morphogenetic protein-2. J Bone Joint Surg Am 2009; 91 (05) 1181-1189
- 4 Truumees E, Majid K, Brkaric M. Anterior lumbar interbody fusion in the treatment of mechanical low back pain. Semin Spine Surg 2008; 20 (02) 113-125
- 5 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 2004; 1 (01) 24-30
- 6 Strube P, Hoff E, Hartwig T, Perka CF, Gross C, Putzier M. Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months. J Spinal Disord Tech 2012; 25 (07) 362-369
- 7 Zhang JD, Poffyn B, Sys G, Uyttendaele D. Are stand-alone cages sufficient for anterior lumbar interbody fusion?. Orthop Surg 2012; 4 (01) 11-14
- 8 Udby PM, Bech-Azeddine R. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease: A pilot study and a literature review. Clin Neurol Neurosurg 2015; 133: 64-69
- 9 Kim JS, Kim DH, Lee SH, Park CK, Hwang JH, Cheh G. , et al. Comparison study of the instrumented circumferential fusion with instrumented anterior lumbar interbody fusion as a surgical procedure for adult low-grade isthmic spondylolisthesis. World Neurosurg 2010; 73 (05) 565-571
- 10 Lammli J, Whitaker MC, Moskowitz A, Duong J, Dong F, Felts L. , et al. Stand-alone anterior lumbar interbody fusion for degenerative disc disease of the lumbar spine: results with a 2-year follow-up. Spine 2014; 39 (15) E894-E901
- 11 Madan SS, Boeree NR. Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 2003; 12 (06) 567-575
- 12 Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine 2000; 25 (20) 2608-2615
- 13 Pilitsis JG, Lucas DR, Rengachary SS. Bone healing and spinal fusion. Neurosurg Focus 2002; 13 (06) e1
- 14 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
- 15 Freyd M. The graphic rating scale. J Educ Psychol 1923; 43: 83-102
- 16 Sasso RC, Kitchel SH, Dawson EG. A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device. Spine 2004; 29 (02) 113-122 , discussion 121–2
- 17 Pavlov PW, Meijers H, van Limbeek J, Jacobs WC, Lemmens JA, Obradov-Rajic M. , et al. Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation. Spine 2004; 29 (17) 1893-1899 , discussion 1900
- 18 Choi KC, Ryu KS, Lee SH, Kim YH, Lee SJ, Park CK. Biomechanical comparison of anterior lumbar interbody fusion: stand-alone interbody cage versus interbody cage with pedicle screw fixation -- a finite element analysis. BMC Musculoskelet Disord 2013; 14: 220
- 19 Cain CM, Schleicher P, Gerlach R, Pflugmacher R, Scholz M, Kandziora F. A new stand-alone anterior lumbar interbody fusion device: biomechanical comparison with established fixation techniques. Spine 2005; 30 (23) 2631-2636
- 20 McCarthy MJH, Ng L, Vermeersch G, Chan D. A radiological comparison of anterior fusion rates in anterior lumbar interbody fusion. Global Spine J 2012; 2 (04) 195-206
- 21 Anjarwalla NK, Morcom RK, Fraser RD. Supplementary stabilization with anterior lumbar intervertebral fusion--a radiologic review. Spine 2006; 31 (11) 1281-1287
- 22 El Masry MA, Badawy WS, Rajendran P, Chan D. Combined anterior interbody fusion and posterior pedicle screw fixation in patients with degenerative lumbar disc disease. Int Orthop 2004; 28 (05) 294-297
- 23 Oxland TR, Lund T. Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 2000; 9 (Suppl. 01) S95-S101
- 24 Tzermiadianos MN, Mekhail A, Voronov LI, Zook J, Havey RM, Renner SM. , et al. Enhancing the stability of anterior lumbar interbody fusion: a biomechanical comparison of anterior plate versus posterior transpedicular instrumentation. Spine 2008; 33 (02) E38-E43
- 25 Beaubien BP, Freeman AL, Turner JL, Castro CA, Armstrong WD, Waugh LG. , et al. Evaluation of a lumbar intervertebral spacer with integrated screws as a stand-alone fixation device. J Spinal Disord Tech 2010; 23 (05) 351-358
- 26 Gertzbein SD, Hollopeter MR, Hall S. Pseudarthrosis of the lumbar spine. Outcome after circumferential fusion. Spine 1998; 23 (21) 2352-2356 , discussion 2356–7
- 27 Chiriano J, Abou-Zamzam Jr AM, Urayeneza O, Zhang WW, Cheng W. The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J Vasc Surg 2009; 50 (01) 148-151
- 28 Mobbs RJ, Phan K, Daly D, Rao PJ, Lennox A. Approach-related complications of anterior lumbar interbody fusion: results of a combined spine and vascular surgical team. Global Spine J 2016; 6 (02) 147-154
- 29 Wood KB, Devine J, Fischer D, Dettori JR, Janssen M. Vascular injury in elective anterior lumbosacral surgery. Spine 2010; 35 (9, Suppl): S66-S75
- 30 Quraishi NA, Konig M, Booker SJ, Shafafy M, Boszczyk BM, Grevitt MP. , et al. Access related complications in anterior lumbar surgery performed by spinal surgeons. Eur Spine J 2013; 22 (Suppl. 01) S16-S20