The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases.
METHODS
This study retrospectively examines outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior carbon fiber cages and 360 degrees fusion in spondylolisthesis.


OBJECTIVE
The goals were to examine the outcomes and perioperative complications of using anterior column support in the treatment of various types of spondylolisthesis.


BACKGROUND
In 2000, Brantigan et al reported the Brantigan interbody fusion cage used as a posterior lumbar interbody fusion in the US IDE clinical trial. This is the largest series to date of TLIF cages specifically used in the treatment of spondylolisthesis.


METHODS
A comprehensive long-term follow-up study was conducted to evaluate the fusion success and morbidity following implantation with an anterior column support and posterior pedicle screw fixation. The 120 patients with spondylolisthesis were comprised by 11 cases, dysplastic; 58 cases, degenerative; and 51 cases, isthmic-acquired spondylolisthesis. Anterior column support was either a rectangular carbon fiber/PEEK device or a cylindrical carbon fiber/PEEK device. Twenty-eight cases (23%) were revisions.


RESULTS
There were no pseudarthrosis, instrumentation failures, or significant subsidence at the TLIF level. The disc space height and foraminal height were restored as part of the surgical procedure. Disc height, as measured from the posterior edge of the superior vertebral body, increased from a mean of 5.6 mm before surgery to a mean of 9.3 mm after surgery. Although reduction of the slip was not the primary goal during the surgical procedure for the 120 cases with spondylolisthesis (isthmic-acquired = 51, degenerative = 58, and dysplastic = 11), the 23% slip reduction achieved at surgery was maintained at follow-up. Mean operative time was 143 +/- 33 minutes (range, 70-255 minutes) for all cases. Mean blood loss was 724 +/- 431 mL (range, 300-2,500 mL). There were seven incidental durotomies and three infections. One patient with Grade I degenerative spondylolisthesis required revision of the carbon fiber cage for posterior migration secondary to a traumatic event 3 months after surgery. Fusion success was 98% using the criteriaof Lenke for the posterior fusion and Brantigan and Steffee for the TLIF graft incorporation.


CONCLUSIONS
Interbody cages in spondylolisthesis are useful to increase neuroforaminal height, to facilitate reduction, and to improve the chances of achieving a successful 360 degrees fusion.
McAfee
Paul C
PC
Spine and Scoliosis Center, St. Joseph's Hospital, Baltimore, MD, USA. mack8132@aol.com
DeVine
John G
JG
Chaput
Christopher D
CD
Prybis
Brad G
BG
Fedder
Ira L
IL
Cunningham
Bryan W
BW
Farrell
Dennis J
DJ
Hess
Samuel J
SJ
Vigna
Franco E
FE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D019299:Decompression, Surgical / Q000009:adverse effects; D020878:Device Removal; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013126:Spinal Nerve Roots / Q000601:surgery; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents