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Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion

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Abstract

Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. The purpose of this study was to assess and compare the outcome of instrumented circumferential fusion through a posterior approach [PLIF and posterolateral fusion (PLF)] with instrumented ALIF using the Hartshill horseshoe cage, for comparable degrees of internal disc disruption and clinical disability. It was designed as a prospective study, comparing the outcome of two methods of instrumented interbody fusion for internal disc disruption. Between April 1994 and June 1998, the senior author (N.R.B.) performed 39 instrumented ALIF procedures and 35 instrumented circumferential fusion with PLIF procedures. The second author, an independent assessor (S.M.), performed the entire review. Preoperative radiographic assessment included plain radiographs, magnetic resonance imaging (MRI) and provocative discography in all the patients. The outcome in the two groups was compared in terms of radiological improvement and clinical improvement, measured on the basis of improvement of back pain and work capacity. Preoperatively, patients were asked to fill out a questionnaire giving their demographic details, maximum walking distance and current employment status in order to establish the comparability of the two groups. Patient assessment was with the Oswestry Disability Index, quality of life questionnaire (subjective), pain drawing, visual analogue scale, disability benefit, compensation status, and psychological profile. The results of the study showed a satisfactory outcome (score≤30) on the subjective (quality of life questionnaire) score of 71.8% (28 patients) in the ALIF group and 74.3% (26 patients) in the PLIF group (P>0.05). On categorising Oswestry Index scores into "excellent", "better", "same", and "worse", we found no difference in outcome between the two groups: 79.5% (n=31) had satisfactory outcome with ALIF and 80% (n=28) had satisfactory outcome with PLIF. The rate of return to work was no different in the two groups. On radiological assessment, we found two nonunions in the circumferential fusion (PLIF) group (94.3% fusion rate) and indirect evidence of no nonunions in the ALIF group. There was no significant difference between the compensation rate and disability benefit rate between the two groups. There were three complications in ALIF group and four in the PLIF (circumferential) group. On the basis of these results, we conclude that it is possible to treat discogenic back pain by anterior interbody fusion with Hartshill horseshoe cage or with circumferential fusion using instrumented PLIF.

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References

  1. Brantigan JW, Steffee AD (1993) A carbon fibre implant to aid interbody fusion: two-year clinical results in the first 26 patients. Spine 18:2106–2116

    CAS  PubMed  Google Scholar 

  2. Brantigan JW, Steffee AD, Geiger JM (1991) Carbon fiber implant to aid interbody lumbar fusion: mechanical testing. Spine 16 [Suppl]:277–282

    Google Scholar 

  3. Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM (1996) Lumbar interbody fusion using the Brantigan I/F cage for PLIF and the VSP pedicle screw system: two-year results of a food and drug administration IDE clinical trial. Prepublication data submitted to FDA

  4. Calandruccio RA, Benton BF (1964) Anterior lumbar fusion Clin Orthop 35:63–68

    CAS  Google Scholar 

  5. Chow SP, Leong JCY, Ma A, Yay A (1980) Anterior spinal fusion for deranged lumbar intervertebral disc: a review of 97 cases. Spine 5:452–458

    CAS  PubMed  Google Scholar 

  6. Collis JS (1985) Total disc replacement. A modified posterior lumbar interbody fusion. Clin Orthop 193:64–67

    PubMed  Google Scholar 

  7. Crock HV (1970) A reappraisal of intervertebral disc lesions. Med J 1:983–989

    CAS  Google Scholar 

  8. Crock HV (1976) Observations on management of failed spinal operations. J Bone Joint Surg Br 58:193–199

    CAS  PubMed  Google Scholar 

  9. Deyo RA, Battie M, Beurskens AJHM, et al (1998) Outcome measures for low back pain research. Spine 23:2003–2013

    Article  CAS  PubMed  Google Scholar 

  10. Enker P, Steffee AD (1994) Interbody fusion and instrumentation. Clin Orthop 300:90–101

    Google Scholar 

  11. Evans H (1989) Biomechanics of lumbar fusion. In: Lin PM, Gill K (eds) Lumbar interbody fusion. Principles and techniques in spine surgery. Aspen Rockville, pp 9–13

  12. Fairbank JCT, Couper J, Davies JB, O'Brien JP (1980) The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  13. Flynn JC, Hoque MA (1979) Anterior fusion of the lumbar spine. J Bone Joint Surg Am 61:1143–1150

    PubMed  Google Scholar 

  14. Frymoyer JW (1981) The role of spine fusion: Question 3. Spine 6:284–290

    Google Scholar 

  15. Fujimaki A, Crock HV, Bedbrook GM (1982) The results of 150 anterior lumbar interbody fusion operations performed by two surgeons in Australia. Clin Orthop 165:164–167

    PubMed  Google Scholar 

  16. Gertzbein SD, Betz R, Clements D, et al (1996) Semirigid instrumentation in the management of lumbar spine conditions combined with circumferential fusion. A multicenter study. Spine 21:1918–1925

    Article  CAS  PubMed  Google Scholar 

  17. Greenough CG, Peterson MD, Hadlow S, Fraser RD (1998) Instrumented posterolateral lumbar fusion. Spine 23:479–486

    CAS  PubMed  Google Scholar 

  18. Hahnel H, Muschik M, Zippel H, Gutsche H (1991) Lumbale Segmentspondylodese isoliert ventral oder kombiniert dorsoventral? Z Orthop Ihre Grenzgeb 129:197–203

    CAS  PubMed  Google Scholar 

  19. Hanley EN, Levy JA (1989) Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results. Spine 14:48–50

    PubMed  Google Scholar 

  20. Harmon PH (1963) Anterior excision and vertebral body fusion for intervertebral disc syndromes of the lower lumbar spine. Clin Orthop 26:107–127

    CAS  Google Scholar 

  21. Holte DC, O'Brien JP, Renton P (1994) Anterior lumbar fusion using a hybrid interbody graft. Eur Spine J 3:32–38

    CAS  PubMed  Google Scholar 

  22. Hoover NW (1968) Methods of lumbar spine fusion. J Bone Joint Surg Am 50:194–210

    Google Scholar 

  23. Inoue S, Watanabe T (1984) Anterior discectomy and interbody fusion for lumbar disc herniation. Clin Orthop 183:22–31

    PubMed  Google Scholar 

  24. Kirkaldy-Willis WH, Hill RJ (1979) A more precise diagnosis for low back pain. Spine 4:102

    PubMed  Google Scholar 

  25. Kozak JA, Heilman AE, O'Brien JP (1994) Anterior lumbar fusion options. Clin Orthop 300:45–51

    PubMed  Google Scholar 

  26. Krause P, Halm H (1993) Combined anterior and posterior fusion with MPDS and titanium cage on lumbosacral instabilities. First International Meeting on Munster posterior and anterior double rod system. Munster

  27. Kuslich SD, Ulstrom CL, Michael CJ (1991) The tissue origin of low back pain and sciatica. Orthop Clin North Am 22:181–187

    CAS  Google Scholar 

  28. Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD (1998) The Bagby and Kuslich method of lumbar interbody fusion. Spine 23:1267–1279

    CAS  PubMed  Google Scholar 

  29. Leufven C, Nordwall A (1999) Management of chronic disabling low back pain with 360° fusion. Spine 24:2042–2045

    Article  CAS  PubMed  Google Scholar 

  30. Liljenqvist U, O'Brien JP, Renton P (1998) Simultaneous combined anterior and posterior lumbar fusion with femoral cortical allograft. Eur Spine J 7:125–131

    CAS  PubMed  Google Scholar 

  31. Lin PM, Cautini RA, Joyce MF (1983) Posterior lumbar interbody fusion. Clin Orthop 180:154–168

    PubMed  Google Scholar 

  32. Loguidice VA, Johnson RG, Guyer RD, et al (1988) Anterior lumbar interbody fusion. Spine 13:366–369

    CAS  PubMed  Google Scholar 

  33. Madan S, Boeree NR (2001) Containment and stabilization of bone graft in anterior lumbar interbody fusion: the role of the Hartshill horseshoe cage. J Spinal Disord 14:104–108

    CAS  PubMed  Google Scholar 

  34. Main CJ (1983) The Multiple Somatic Perception Questionnaire (MSPQ). J Psychosom Res 27:503–514

    CAS  PubMed  Google Scholar 

  35. Mayer TG, Kondraske G, Mooney V, Carmichael TW, Butsch R (1989) Lumbar myoelectric spectral analysis for endurance assessment, a comparison of normals with deconditioned subjects. Spine 9:986–991

    Google Scholar 

  36. Mooney V (1987) Where is the pain coming from? Spine 12:54–59

    Google Scholar 

  37. Nachemson A, Zdeblick TA, O'Brien JP (1996) Controversy. Lumbar disc disease with discogenic pain. Spine 21:1835–1838

    CAS  PubMed  Google Scholar 

  38. Newman MH, Grinstead GL (1992) Anterior lumbar interbody fusion for internal disc disruption. Spine 17:831–833

    CAS  PubMed  Google Scholar 

  39. O'Brien JP, Holte DC (1992) Simultaneous combined anterior and posterior fusion. Eur Spine J 1:2–6

    Google Scholar 

  40. Oliver CW, Greenough CG (1994) The role of lumbar paraspinal surface electromyography in low back pain. J Bone Joint Surg Br 76[Suppl]:44

  41. Paajanen H, Erkintalo M, Kuusela T, Dahlstrom S, Kormano M (1989) Magnetic resonance study of disc degeneration in young low back pain patients. Spine 14:982–985

    CAS  PubMed  Google Scholar 

  42. Penta M, Fraser RD (1997) Anterior lumbar interbody fusion: a minimum 10-year follow-up. Spine 22:2429–2434

    CAS  PubMed  Google Scholar 

  43. Schechter NA, France MP, Lee CK (1991) Painful internal disc derangements of the lumbosacral spine: discographic diagnosis and treatment by posterior lumbar interbody fusion. Orthopedics 14:447–451

    CAS  PubMed  Google Scholar 

  44. Selby DK, Henderson MJ, Blumenthal S, Dossett D (1988) Anterior lumbar fusion. In: Cauthen JC (ed) Lumbar spine surgery, 2nd edn. Williams and Wilkins, Baltimore, pp 248–260

  45. Snook SH (1982) Low back pain in industry. In: White AA III, Gordon SL (eds) American Academy of Orthopaedic Surgeons Symposium on Idiopathic Low Back Pain. Mosby, St. Louis, pp 23–38

  46. Spengler DM, Bigos SJ, Martin NA, Zeh J, Fisher L, Nachemson A (1986) Back injuries in industry: a retrospective study. I. Overview and cost analysis. Spine 11:241–245

    CAS  PubMed  Google Scholar 

  47. Stauffer RN, Coventry MB (1972) Anterior interbody lumbar fusion: analysis of Mayo Clinic series. J Bone Joint Surg Am 54:756–768

    CAS  PubMed  Google Scholar 

  48. Suk S, Lee C-K, Kim W-J, Lee J-H, Cho K-J, Kim H-G (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:210–220

    Article  CAS  PubMed  Google Scholar 

  49. Tandon V, Campbell F, Ross ERS (1999) Posterior lumbar interbody fusion. Spine 24:1833–1838

    Google Scholar 

  50. Temple HT, Kruse RW, van Dam BE (1994) Lumbar and lumbosacral fusion using Steffee instrumentation. Spine 19:537–541

    CAS  PubMed  Google Scholar 

  51. Tiusanen H, Seitsalo S, Osterman K, Soini J (1996) Anterior interbody lumbar fusion in severe low back pain. Clin Orthop 324:153–163

    PubMed  Google Scholar 

  52. Tullberg T, Brandt B, Rydberg J, Fritzell P (1996) Fusion rate after posterior lumbar interbody fusion with carbon fibre implant: 1-year follow-up of 51 patients. Eur Spine J 5:178–182

    CAS  PubMed  Google Scholar 

  53. Turner JA, Ersek M, Herron L, et al (1992) Patient outcomes after lumbar spinal fusion. JAMA 268:907–911

    CAS  PubMed  Google Scholar 

  54. Vamvanij V, Frederickson BE, Thorpe JM, Stadnick ME, Yuan HA (1998) Surgical treatment of internal disc disruption: an outcome study of four fusion techniques. J Spinal Disord 11:375–382

    CAS  PubMed  Google Scholar 

  55. Weinstein J, Claverie W, Gibson S (1988) The pain of discography. Spine 13:1344–1348

    CAS  PubMed  Google Scholar 

  56. Yoshizawa H, O'Brien JP, Smith WT, Trumper M (1980) The neuropathology of intervertebral disc removed for low back pain. J Pathol 132:95–104

    CAS  PubMed  Google Scholar 

  57. Zung WWK (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70

    CAS  Google Scholar 

Download references

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Madan, S.S., Boeree, N.R. Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 12, 567–575 (2003). https://doi.org/10.1007/s00586-002-0516-5

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