title: Lumbar-sacral fusion by a combined approach using interbody PEEK cage and posterior pedicle-screw fixation: clinical and radiological results from a prospective study.
abstract: BACKGROUND
  This prospective series evaluated the clinical and radiological results of a circumferential lumbar fusion achieved by a combined approach in one stage (anterior then posterior) using interbody PEEK cages and posterior pedicle-screw fixation.
  
  
  OBJECTIVE
  The combined approach in one stage is a safe and efficient technique with few complications to achieve a fusion with a satisfying clinical and radiological outcome.
  
  
  METHODS
  Thirty-nine consecutive patients were prospectively included, with a one-year clinical and radiological minimum follow-up, from December 2008 to July 2011. All patients suffering from degenerative disc disease or low-grade isthmic spondylolisthesis requiring L5S1, L4L5 or L4S1 spinal fusions were included. Clinical outcome was assessed using VAS, ODI and Rolland-Morris scores. Radiological outcome was assessed by analyzing PI, PT, lumbar lordosis, segmental lordosis, disc height, C7/CSFD ratio on full spine radiographies and the quality of bone fusion on a CT scan at 1-year follow-up. Blood loss, surgery time and adverse events were also recorded.
  
  
  RESULTS
  Twenty-nine patients (74%) were operated for a lumbar degenerative disc disease and 10 patients (26%) for an isthmic spondylolisthesis. Mean age was 46 (± 10.1) years old. Clinical outcome were satisfactory. VAS, ODI and Rolland-Morris scores substantially improved. Mean follow-up was 22.5 months (± 8.7). Mean surgery time was 227 min (± 41.4) for complete surgical procedure time. Mean blood loss was 308 mL (± 179.2) for total surgery. Fusion was assessed in all cases. Disc height and segmental lordosis significantly improved in postoperative. The segmental lordosis at operated level(s) increased by 8.5° (± 5) regardless of the level, and by 11.6° (± 6) for L5-S1.
  
  
  CONCLUSIONS
  The combined procedure meets the requested criteria for a lumbar fusion in terms of clinical and functional results, fusion rates, and restoration of segmental lordosis. It cumulates the advantages of the anterior and posterior approach performed alone and should be considered by surgeons before realizing a lumbar fusion.
authors.affiliation: Unité 1 chirurgie orthopédique du Rachis, Groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: boissierelouis@yahoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Boissiere
authors.forename: G
authors.initials: G
authors.lastname: Perrin
authors.forename: J
authors.initials: J
authors.lastname: Rigal
authors.forename: F
authors.initials: F
authors.lastname: Michel
authors.forename: C
authors.initials: C
authors.lastname: Barrey
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Combined approach; Lordosis; Neurosurgical procedures; Orthopedic surgical procedure; Sagittal balance; Spinal fusion