title: Low fusion rate after L5-S1 laparoscopic anterior lumbar interbody fusion using twin stand-alone carbon fiber cages.
abstract: METHODS
  Prospective study of a cohort of patients who underwent L5-S1 laparoscopic anterior lumbar interbody fusion.
  
  
  OBJECTIVE
  To assess the fusion rate and the clinical outcome more than 2 years after L5-S1 laparoscopic anterior lumbar interbody fusion using twin stand-alone carbon-fiber cages.
  
  
  BACKGROUND
  The first reports on laparoscopic anterior lumbar interbody fusion using stand-alone cages appeared in 1995. Since then several articles have reported contradictory data regarding fusion rate. There are no publications describing the fusion rate of stand-alone lumbar carbon-fiber cages.
  
  
  METHODS
  The authors evaluated 12 patients (mean age 36.5 years) in whom endoscopic L5-S1 anterior lumbar interbody fusion was performed using twin stand-alone laparoscopic carbon-fiber cages. Clinical evaluation was carried out prospectively by the use of three self-evaluation scales. Radiologic evaluation was performed by an independent radiologist using dynamic flexion-extension films and CT scans at 6 and 12 months after surgery and subsequently every year until fusion was demonstrated.
  
  
  RESULTS
  After a mean follow-up of 36.6 months (range 24-63 months) the clinical condition of the patients was significantly better than their preoperative status: visual analog scale (P < 0.01), Prolo score (P < 0.05), and Waddell Disability Index (P < 0.01). L5-S1 mobility did not exceed 5 degrees in any dynamic study. However, the overall CT scan fusion rate at 2 years of follow-up was 16.6%. Three years after surgery, CT demonstrated fusion in one of five patients.
  
  
  CONCLUSIONS
  Two years after endoscopic L5-S1 anterior lumbar interbody fusion using twin stand-alone laparoscopic carbon-fiber cages, the fusion rate was unacceptably low. However, the clinical outcomes of these patients were significantly improved compared with their preoperative status.
authors.affiliation: Unitat de Cirurgia del Raquis, Hospitals Vall d'Hebron, Barcelona, Spain. 24361fpu@comb.es
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.forename: Oriol
authors.initials: O
authors.lastname: Puig
authors.forename: Antoni
authors.initials: A
authors.lastname: Rivas
authors.forename: Joan
authors.initials: J
authors.lastname: Bagó
authors.forename: Carlos
authors.initials: C
authors.lastname: Villanueva
mesh_terms: D000328:Adult; D002244:Carbon / Q000009:adverse effects; D000077482:Carbon Fiber; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects*; D013123:Spinal Fusion / Q000009:adverse effects*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000077482:Carbon Fiber; D002244:Carbon