Anterior Lumbar Interbody Fusion with Stand-Alone Interbody Cage in Treatment of Lumbar Intervertebral Foraminal Stenosis : Comparative Study of Two Different Types of Cages

Abstract

Objective : This retrospective study was performed to evaluate the clinical and radiological results of anterior lumbar interbody fusion (ALIF) using two different stand-alone cages in the treatment of lumbar intervertebral foraminal stenosis (IFS). Methods : A total of 28 patients who underwent ALIF at L5-S1 using stand-alone cage were studied [Stabilis ® (Stryker, Kalamazoo, MI, USA); 13, SynFix-LR ® (Synthes Bettlach, Switzerland); 15]. Mean follow-up period was 27.3 ± 4.9 months. Visual analogue pain scale (VAS) and Oswestry disability index (ODI) were assessed. Radiologically, the change of disc height, intervertebral foraminal (IVF) height and width at the operated segment were measured, and fusion status was defined. Results : Final mean VAS (back and leg) and ODI scores were significantly decreased from preoperative values (5.6 ± 2.3 � 2.3 ± 2.2, 6.3 ± 3.2 �1.6 ± 1.6, and 53.7 ± 18.6 � 28.3 ± 13.1, respectively), which were not different between the two devices groups. In Stabilis ® group, postoperative immediately increased disc and IVF heights (10.09 ± 4.15 mm � 14.99 ± 1.73 mm, 13.00 ± 2.44 mm � 16.28 ± 2.23 mm, respectively) were gradually decreased, and finally returned to preoperative value (11.29 ± 1.67 mm, 13.59 ± 2.01 mm, respectively). In SynFix-LR ® group, immediately increased disc and IVF heights (9.60 ± 2.82 mm � 15.61 ± 0.62 mm, 14.01 ± 2.53 mm � 21.27 ± 1.93 mm, respectively) were maintained until the last follow up (13.72 ± 1.21 mm, 17.87 ± 2.02 mm, respectively). The changes of IVF width of each group was minimal pre-and postoperatively. Solid arthrodesis was observed in 11 patients in Stabilis group (11/13, 84.6%) and 13 in SynFix-LR ® group (13/15, 86.7%). Conclusion : ALIF using stand-alone cage could assure good clinical results in the treatment of symptomatic lumbar IFS in the mid-term follow up. A degree of subsidence at the operated segment was different depending on the device type, which was higher in Stabilis ® group.

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

“…Strube et al [28] Schimmel et al [25] Cho et al [27] Behrbalk et al [26] Original study cohort (n=) n.a.…”

“…Strube et al [28] Schimmel et al [25] Cho et al [27] Behrbalk et al [26] Overall complications were observed, which the authors referred to a reduced rhBMP-2 dose of 6 mg/level as opposed to 12 mg/level that was used in previous reports [74]. Burkus et al [70] in a multicenter prospective randomized trial with tapered interbody stand-alone fusion cages reported 94.5 % fusion rates in the investigational cohort and concluded that the use of rhBMP-2 can eliminate the need for harvesting iliac crest bone graft.…”

“…Despite these potential advantages, previously published data on ASAF techniques have reported controversial and at times contradictory results [20][21][22][23][24][25][26][27][28].…”

Stand-alone ALIF with integrated intracorporeal anchoring plates in the treatment of degenerative lumbar disc disease: a prospective study on 65 cases

“…Despite positive results [6], the stability of stand-alone cages has been questioned during the low muscular preloading phases when the cage has been suspected to be less stable [7]. The instability during the bone healing process is hypothesized to be one of the main reasons for pseudarthrosis [8][9][10] and subsidence [3]. Compared with standalone cage, supplementary fixation increases the stiffness and stability [3] and significantly improves the fusion rate [11].…”

“…Anterior plating has been proposed but increases blood loss and length of procedure. Furthermore, anatomical configuration in L4-L5 and L5-S1 can make it either difficult or impossible, so lower profile cages integrating anterior fixation screws were designed to facilitate these cases [10,12,14].…”