Low fusion rate after L5-S1 laparoscopic anterior lumbar interbody fusion using twin stand-alone carbon fiber cages.
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.
Pellisé
Ferran
F
Unitat de Cirurgia del Raquis, Hospitals Vall d'Hebron, Barcelona, Spain. 24361fpu@comb.es
Puig
Oriol
O
Rivas
Antoni
A
Bagó
Joan
J
Villanueva
Carlos
C
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
D000077482:Carbon Fiber; D002244:Carbon