Anterior Lumbar Interbody Fusion: Two-Year Results with a Modular Interbody Device

Keith Lynn Jackson, Chevas Yeoman, Woosik M. Chung, James L. Chappuis, Brett Freedman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Study Design: Retrospective case series. Purpose: To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device. Overview of Literature: Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon. Methods: Forty-three consecutive patients underwent ALIF with (n=30) or without (n=11) supplemental instrumentation. Two patients underwent ALIF to treat failed posterior instrumented fusion. The primary outcome measure was presence of fusion as assessed by computed tomography. Secondary outcome measures were lordosis, intervertebral lordotic angle (ILA), disc height, subsidence, Bridwell fusion grade, technical complications and pain score. Interobserver reliability of radiographic outcome measures was calculated. Results: Forty-three patients underwent ALIF of 73 motion segments. ILA and disc height increased over baseline, and this persisted through final follow-up (p <0.01). Solid anterior interbody fusion was present in 71 of 73 motion segments (97%). The amount of new bone formation in the interbody space increased over serial imaging. Subsidence >4 mm occurred in 12% of patients. There were eight surgical complications (19%): one major (reoperation for nonunion/progressive subsidence) and seven minor (five subsidence, two malposition). Conclusions: The use of a modular interbody device for ALIF resulted in a high rate of radiographic fusion and a low rate of subsidence. The large endplate and modular design of the device may contribute to a low rate of subsidence as well as maintenance of ILA and lordosis. Previously reported quantitative radiographic outcome measures were found to be more reliable than qualitative or categorical measures.

Original languageEnglish (US)
Pages (from-to)591-598
Number of pages8
JournalAsian Spine Journal
Volume8
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Outcome Assessment (Health Care)
Equipment and Supplies
Lordosis
Equipment Design
Reoperation
Retrospective Studies
Tomography
Maintenance
Pain

Keywords

  • Interbody cage
  • Low back pain
  • Lumbar spine

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Anterior Lumbar Interbody Fusion : Two-Year Results with a Modular Interbody Device. / Jackson, Keith Lynn; Yeoman, Chevas; Chung, Woosik M.; Chappuis, James L.; Freedman, Brett.

In: Asian Spine Journal, Vol. 8, No. 5, 01.01.2014, p. 591-598.

Research output: Contribution to journalArticle

Jackson, Keith Lynn ; Yeoman, Chevas ; Chung, Woosik M. ; Chappuis, James L. ; Freedman, Brett. / Anterior Lumbar Interbody Fusion : Two-Year Results with a Modular Interbody Device. In: Asian Spine Journal. 2014 ; Vol. 8, No. 5. pp. 591-598.
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abstract = "Study Design: Retrospective case series. Purpose: To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device. Overview of Literature: Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon. Methods: Forty-three consecutive patients underwent ALIF with (n=30) or without (n=11) supplemental instrumentation. Two patients underwent ALIF to treat failed posterior instrumented fusion. The primary outcome measure was presence of fusion as assessed by computed tomography. Secondary outcome measures were lordosis, intervertebral lordotic angle (ILA), disc height, subsidence, Bridwell fusion grade, technical complications and pain score. Interobserver reliability of radiographic outcome measures was calculated. Results: Forty-three patients underwent ALIF of 73 motion segments. ILA and disc height increased over baseline, and this persisted through final follow-up (p <0.01). Solid anterior interbody fusion was present in 71 of 73 motion segments (97{\%}). The amount of new bone formation in the interbody space increased over serial imaging. Subsidence >4 mm occurred in 12{\%} of patients. There were eight surgical complications (19{\%}): one major (reoperation for nonunion/progressive subsidence) and seven minor (five subsidence, two malposition). Conclusions: The use of a modular interbody device for ALIF resulted in a high rate of radiographic fusion and a low rate of subsidence. The large endplate and modular design of the device may contribute to a low rate of subsidence as well as maintenance of ILA and lordosis. Previously reported quantitative radiographic outcome measures were found to be more reliable than qualitative or categorical measures.",
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