Anterior lumbar fusion using a hybrid interbody graft

Abstract

This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels) utilizing a "hybrid" interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft bone. The average age at surgery was 38 years (range 17-64 years), and follow-up averaged 1.4 years (range 1.0-2.4 years). Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of the hybrid graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion

“…The Hartshill horseshoe cage in this study achieves immediate stabilisation, and the screws in the superior and inferior vertebral bodies provide rigid fixation. This instrumentation avoids the need for posterior stabilisation, which is often required with other cages or bone grafts in ALIF procedures [11,21,30]. The cage also prevents the graft sinkage through the vertebral endplates, prevents graft extrusion, opens up the neural foramina and recreates the normal lordosis of the lumbar segment.…”

Cages: designs and concepts

“…Higher fusion rates have been reported for femoral ring allografts when supplemented with posterior translaminar screw fixation [8]. Likewise, threaded cages were reported to result in higher fusion rates when supplemented with pedicle screw fixation [24].…”

Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts

“…Monosegmental anterior lumbar interbody fusion (ALIF) using autologous bone grafts has a reported failure rate of 3-25% [5,7,19,20]. Monosegmental posterior interbody fusion (PLIF) using autologous grafts will fuse in 88-98% of cases [18].…”

“…This has resulted in the use of different materials such as bioceramics, corals, allografts, and constructs made from carbon fibre or metal. The results of fusions performed using these techniques are inconsistent and not convincing [1,5,9,10].…”