title: Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation.
abstract: METHODS
  Fifty-two patients with degenerative disc disease underwent single- or double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation as treatment for degenerative disc disease and were prospectively followed for 4 years.
  
  
  OBJECTIVE
  To test the clinical performance of anterior lumbar interbody fusion with SynCage, with emphasis on the safety and efficacy of the surgical procedure and the ability to restore anatomy and fuse the motion segment.
  
  
  BACKGROUND
  Anterior lumbar interbody fusion using femoral allograft and/or autologous bone has a high complication rate. With cage technology, some of these complications can be avoided. The design characteristics of the SynCage offer advantages in restoring and maintaining intervertebral height and restoration of lumbar lordosis.
  
  
  METHODS
  Thirty-three patients underwent single-level and 19 patients double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation (translaminar screws, n = 32 or pedicle screws, n = 10). Radiologic and functional results (VAS and Oswestry score) were evaluated.
  
  
  RESULTS
  Intervertebral height was corrected from an average of 8.7 to 17.6 mm. Lordosis of the fused segment was significantly increased (average 10.6 degrees for the fused segment and 8 degrees for lumbosacral lordosis). After 2 years, there was radiologic evidence for fusion in 70 of 71 (98.6%) levels. Functional scores showed a significant improvement in pain and function up to the 2-year follow-up observation. At the 4-year follow-up observation, there was some loss of the initial improvement in VAS and Oswestry scores. Despite this loss, they remained significantly better than the preoperative scores.
  
  
  CONCLUSIONS
  Anterior lumbar interbody fusion with SynCage and additional posterior fixation is a safe and effective procedure. Intervertebral height is corrected, and lumbosacral lordosis is restored. An initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up observation, but 4-year results are still significantly better than the preoperative scores.
authors.affiliation: Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands. p.pavlov@maartenskliniek.nl
authors.forename: Paul W
authors.initials: PW
authors.lastname: Pavlov
authors.forename: Hjalmar
authors.initials: H
authors.lastname: Meijers
authors.forename: Jaques
authors.initials: J
authors.lastname: van Limbeek
authors.forename: Wilco C H
authors.initials: WC
authors.lastname: Jacobs
authors.forename: J Albert M
authors.initials: JA
authors.lastname: Lemmens
authors.forename: Marina
authors.initials: M
authors.lastname: Obradov-Rajic
authors.forename: Marinus
authors.initials: M
authors.lastname: de Kleuver
mesh_terms: D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012447:Sacrum; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome