Anterior lumbar interbody fusion with titanium mesh cages, coralline hydroxyapatite, and demineralized bone matrix as part of a circumferential fusion.
BACKGROUND
Anterior lumbar interbody fusion (ALIF) has become one of the primary choices for eliminating motion between vertebral segments in patients with severe discogenic pain and other lumbar pathologies. Autograft is the gold standard for spinal fusion. However, multiple authors have reported complication and morbidity rates associated with iliac crest harvesting to be as high as 25%. Drawbacks to the use of allograft in the anterior column include slower incorporation rates, the possibility for disease transmission, increasing cost resulting from stringent processing and unavailability on a worldwide basis resulting from religious and economic concerns.


OBJECTIVE
To determine the clinical and arthrodesis efficacy of coralline hydroxyapatite as an osteoconductive bone graft substitute in the anterior lumbar spine using a titanium mesh cage.


METHODS
A series of 50 patients returning for long-term prospective follow-up, implanted with titanium mesh cages filled with coralline hydroxyapatite and demineralized bone matrix for ALIF as part of a circumferential fusion.


METHODS
Long-term clinical and radiographic follow-up were examined for the first 50 patients undergoing this technique by one surgeon.


METHODS
Pain was measured with a visual analog scale and function was measured with the Oswestry Disability Index.


METHODS
All 50 patients underwent successful ALIF with titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix, as well as an autologous posterolateral fusion with rigid posterior instrumentation. Patients filled out follow-up questionnaires and appropriate radiographs were taken.


RESULTS
A solid fusion rate of 96% was achieved. Mean pain decrease was 60% overall. A total of 70% of all patients either returned to work or to full home activities at a mean of 8 months after surgery. Ninety percent felt the surgery was successful.


CONCLUSIONS
The combination of titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix is effective for anterior interbody fusion of the lumbar spine when used as part of a rigidly instrumented circumferential fusion.
Thalgott
John S
JS
International Spinal Development and Research Foundation, 600 South Rancho Drive, Suite 101, Las Vegas, NV 89106, USA. spine@spine-research.org
Giuffre
James M
JM
Klezl
Zendek
Z
Timlin
Marcus
M
D000328:Adult; D000368:Aged; D018775:Bone Demineralization Technique; D018786:Bone Substitutes / Q000627:therapeutic use*; D002516:Ceramics / Q000627:therapeutic use*; D015194:Diffusion Chambers, Culture; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D007902:Length of Stay; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D014025:Titanium; D016896:Treatment Outcome
D018786:Bone Substitutes; D006882:Hydroxyapatites; C119955:coralline hydroxyapatite; D014025:Titanium