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RADIOLOGICAL RESULTS AND FUNCTIONAL IMPROVEMENT IN PATIENTS UNDERGOING ANTERIOR LUMBAR INTERBODY FUSION



Abstract

Introduction: Anterior lumbar interbody fusion (ALIF) with posterior stabilisation is an established treatment for degenerative disc disease.1 Some previous reports have advocated a goal of 360 degree fusion, and condemned posterior stabilisation as it does not achieve fusion of the posterior facet joints.2 Others have claimed that the concept of a ‘locked pseudarthrosis’ gives satisfactory clinical results.3 There is also a contention that private or self-funding patients achieve better results after spinal fusion compared to those treated under compensation or Dept. Veterans Affairs (DVA) schemes.

Methods: Twenty patients who had undergone an ALIF with posterior stabilisation were retrospectively reviewed. All had a follow-up greater than 12 months. 13 patients were private and 7 non-private. The groups were aged and sex matched. Radiological assessment of fusion was made with reconstruction CT scans. Oswestry Disability Index (ODI) scores were recorded preoperatively, 6 months and 12 months post operation.

Results: Patients with locked pseudarthrosis showed no significant difference in outcome compared to those with radiological fusion. Both groups showed signifi cant improvement in ODI scores after ALIF (mean preop. = 52 – range 16-74; mean postop. = 18 – range 0-52; p< 0.01). There was a significantly greater improvement (p< 0.02) in ODI scores in private patients (mean reduction = 41 points) compared to worker’s compensation or DVA patients (mean reduction = 22 points).

Discussion: The results indicate that ALIF with posterior stabilisation can achieve good clinical results even with a ‘locked pseudarthrosis’. While there is no significant difference between outcomes in different health funding groups shown in the study, carefully patient select for this treatment is the key to success.

The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.

References:

1. Sasso RC, Kitchel SH, Dawson EG. A prospective randomised controlled clinical trial of ALIF using titanium cylindrical threaded fusion device. Spine2004; 29:113–122. Google Scholar

2. Hacker RJ. Comparison of interbody fusion approaches for disabling lower back pain. Spine1997; 22:660–666. Google Scholar

3. Fraser RD in Symposium: A critical discrepancy – A criteria of successful arthrodesis following interbody spinal fusions. Spine2001; 26:320–334. Google Scholar