Stand-alone anterior lumbar interbody fusion for degenerative disc disease of the lumbar spine: results with a 2-year follow-up.
METHODS
Retrospective chart review.


OBJECTIVE
To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand-alone anterior lumbar interbody fusion (ALIF, either 1 or 2 levels) and use of recombinant human bone morphogenetic protein 2 for bony fusion with instrumented fixation.


BACKGROUND
Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion, and total disc replacement. Currently, there has been paucity in the literature on the evaluation of ALIFs.


METHODS
Researchers reviewed a consecutive series of patients with DDD who had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of recombinant human bone morphogenetic protein 2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported.


RESULTS
Patients' 2-year Oswestry Disability Index and visual analogue scale presurgery scores significantly improved (P ≤ 0.0001). Patients' 2-year postoperative disc height was significantly greater than the preoperative disc height at the fused level (P ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intraoperative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360° fusions and total disc replacement.


CONCLUSIONS
Stand-alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at 2 years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level.


METHODS
4.
*University of Kansas School of Medicine, Wichita, KS †Orthopaedics and Sports Medicine at Cypress, Wichita, KS ‡Kansas Orthopaedic Center, Wichita, KS; and §National Center of Innovation for Biomaterials in Orthopaedic Research, Wichita, KS.
John
J
Lammli
M Camden
MC
Whitaker
Alan
A
Moskowitz
Jennifer
J
Duong
Frank
F
Dong
Lara
L
Felts
Geoffrey
G
Konye
Elizabeth
E
Ablah
Paul
P
Wooley
D000328:Adult; D016063:Blood Loss, Surgical; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D059145:Total Disc Replacement / Q000379:methods; D016212:Transforming Growth Factor beta / Q000627:therapeutic use; D016896:Treatment Outcome
D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2