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Stand-alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results With a 2-Year Follow-up

Lammli, John MD*; Whitaker, M. Camden MD; Moskowitz, Alan MD; Duong, Jennifer BA*; Dong, Frank PhD*; Felts, Lara MD*; Konye, Geoffrey MD*; Ablah, Elizabeth PhD, MPH*; Wooley, Paul PhD*,§

doi: 10.1097/BRS.0000000000000393
Clinical Case Series

Study Design. Retrospective chart review.

Objective. To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand-alone anterior lumbar interbody fusion (ALIF, either 1 or 2 levels) and use of recombinant human bone morphogenetic protein 2 for bony fusion with instrumented fixation.

Summary of Background Data. Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion, and total disc replacement. Currently, there has been paucity in the literature on the evaluation of ALIFs.

Methods. Researchers reviewed a consecutive series of patients with DDD who had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of recombinant human bone morphogenetic protein 2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported.

Results. Patients' 2-year Oswestry Disability Index and visual analogue scale presurgery scores significantly improved (P ≤ 0.0001). Patients' 2-year postoperative disc height was significantly greater than the preoperative disc height at the fused level (P ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intraoperative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360° fusions and total disc replacement.

Conclusion. Stand-alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at 2 years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level.

Level of Evidence: 4

Data were collected retrospectively of patients who had a 1-level or 2-level anterior lumbar interbody fusion (ALIF), and clinical and radiological outcomes were reported. ALIFs provided increased functional outcomes, and when compared with 360° fusions and total disc replacements, intraoperative data were found to be better.

*University of Kansas School of Medicine, Wichita, KS

Orthopaedics and Sports Medicine at Cypress, Wichita, KS

Kansas Orthopaedic Center, Wichita, KS; and

§National Center of Innovation for Biomaterials in Orthopaedic Research, Wichita, KS.

Address correspondence and reprint requests to M. Camden Whitaker, MD, Orthopaedics and Sports Medicine at Cypress, 9300 E 29th St N, Ste 205, Wichita, KS 67226; E-mail:

Acknowledgment date: October 1, 2013. First revision date: January 20, 2014. Second revision date: January 30, 2014. Third revision date: March 24, 2014. Acceptance date: March 25, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for the reported indication.

The manuscript includes unlabeled/investigational uses of the products/devices listed below and the status of these is disclosed in the manuscript: rhBMP-2, is FDA approved for spinal fusion anteriorly in skeletally mature patients for treating degenerative disc disease (DDD) at 1 level between L2 and S1; the manuscript discusses results in which rhBMP-2 is used in patients to treat DDD up to 2 levels.

Wichita Center for Graduate Medical Education via the University of Kansas School of Medicine, Wichita, funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy, expert testimony, payment for lectures, payment for development of education presentations, grants/grants pending, patents and travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins