Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine

Anderson, D. Greg; Sayadipour, A.; Shelby, Kevin; Albert, Todd J.; Vaccaro, Alexander R.; Weinstein, Michael

doi:10.1007/s00586-011-1782-x

Cited by 37 publications

(21 citation statements)

References 28 publications

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“…Indeed, such efforts have boosted fusion rates. 2,13,14,16,32 Stand-alone cages with intrinsic plates and screws have also been developed to address needed restoration of the anterior tension band. 15 Cage stability in flexion, extension, and lateral bending now compares favorably with pedicle screw fixation and is superior with respect to rotation.…”

Section: Discussionmentioning

confidence: 99%

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

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Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3–4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3–4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3–4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3–4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

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Section: Discussionmentioning

confidence: 99%

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

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“…Inadequate immobilization of the intervertebral joint during the process of bone healing has been accepted as the main mechanical reason for nonfusion. Accordingly, several types of supplementary fixation, including anterior plates, pedicle screw systems and translaminar screws, have been utilized to improve segmental stability 9–13 . Meanwhile, other clinical studies on stand‐alone ALIF have shown no significant correlation between clinical outcome and fusion rate 14–16 .…”

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confidence: 99%

Are stand‐alone cages sufficient for anterior lumbar interbody fusion?

Zhang

Poffyn

Sys

et al. 2012

Orthopaedic Surgery

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Anterior lumbar interbody fusion (ALIF) has increased in popularity because it has advantages over posterior fusion. Because there is disagreement about the stability of stand-alone cage ALIF, some surgeons use various types of supplementary fixation, including anterior plates, pedicle screw systems and translaminar screws, to increase segmental stability. Many factors associated with both the cages and endplates influence the time of onset and extent of subsidence after use of stand-alone cage ALIF. A large round cage with an adequate central opening is recommended to facilitate maximum contact with the periphery of the endplate. With regard to the relationship between radiographic fusion and recurrence of symptoms with the development of subsidence, most researchers have reported finding no correlation. Subsidence may be due to a process of bone incorporation between cages and endplates. Does subsidence or nonfusion really matter clinically? Further prospective, randomized controlled trials are very much needed to answer these questions.

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“…Anderson et al22 reported the results of 50 patients undergoing ALIF using femoral ring allograft and rhBMP-2 with percutaneous posterior pedicle screw fixation without posterior fusion for degenerative disk disease or SPL. The fusion rate based on plain radiography was reported as greater than 92%.…”

Section: Discussionmentioning

confidence: 99%

A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

McCarthy

Vermeersch

et al. 2012

Global Spine Journal

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Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery–alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery–alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated.

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Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine

Cited by 37 publications

References 28 publications

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Are stand‐alone cages sufficient for anterior lumbar interbody fusion?

A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

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