Clinical application of stand-slone-cage for anterior lumbar interbody fusion in degenerative disc diseases / 中华骨科杂志

ABSTRACT

ObjectiveTo evaluate the effectiveness at anterior lumbar interbody fusion (ALIF) with a single cage alone in treatment of lumbar degenerative disc disease(DDD).MethodsThirty-four patients aged from 26 to 67 years (mean,52) were enrolled in this study,including 10 males and 24 females.Preoperative diagnosis includeddegenerative spondylolithesis in 11 cases,discogenic low back pain in 21,and revision for failed posterior surgery in 2.Objective level located in L4.5 in 12 cases,L5S1 in 20,and double discs(L4.5,L5S1) in 2.All the patients received extraperitoneal approach ALIF.Surgical time,blood loss,perioperative complications and postoperative ambulation were noted.Postoperative function status was evaluated by 100 mm Visual Analog Scale (VAS) and Oswestry Disability Index (ODI50).AP,lateral and dynamic X-rays were routinely taken during follow up,according to which disc height,migration of implant and bony fusion were measured.ResultsAll the surgeries were performed successfully with a mean surgical time of 90 min and blood loss of 200 ml.An injury to the bifurcation of vena cave was encountered in an early case,after meticulous repairing of the vessel,the surgery was finished successfully.Peritoneum rupture was noticed in one case.One case of postoperative cage migration was revised and reinforced with additional fixation system.All the patients were followed up for an average of 36 months(range,12-60).All the patients were satisfied with the pain relief and returned to normal social life and working.VAS decreased from preoperative 70 to postoperative 5,and ODI decreased from 41％ to 6％.All but one migration case reached sound fusion with a fusion rate of 97％.ConclusionOwing to multiple advantages,complete removal of degenerative disc,compressive bone graft,sufficient graft area,early ambulation,less complication,extrapefitoneal approach for ALIF comes up with satisfying clinical outcomes.This mini_invasive technique provides a valuable alternative to treatment of lumbar DDD when appropriate indication is selected.