title: Are stand-alone cages sufficient for anterior lumbar interbody fusion?
abstract: Anterior lumbar interbody fusion (ALIF) has increased in popularity because it has advantages over posterior fusion. Because there is disagreement about the stability of stand-alone cage ALIF, some surgeons use various types of supplementary fixation, including anterior plates, pedicle screw systems and translaminar screws, to increase segmental stability. Many factors associated with both the cages and endplates influence the time of onset and extent of subsidence after use of stand-alone cage ALIF. A large round cage with an adequate central opening is recommended to facilitate maximum contact with the periphery of the endplate. With regard to the relationship between radiographic fusion and recurrence of symptoms with the development of subsidence, most researchers have reported finding no correlation. Subsidence may be due to a process of bone incorporation between cages and endplates. Does subsidence or nonfusion really matter clinically? Further prospective, randomized controlled trials are very much needed to answer these questions.
authors.affiliation: Department of Spine Surgery, Tianjin Hospital, Tianjin, China. bird0496@sina.com
authors.forename: Ji-dong
authors.initials: JD
authors.lastname: Zhang
authors.forename: Bart
authors.initials: B
authors.lastname: Poffyn
authors.forename: Gwen
authors.initials: G
authors.lastname: Sys
authors.forename: Dirk
authors.initials: D
authors.lastname: Uyttendaele
mesh_terms: D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome