title: Non-union rate with stand-alone lateral lumbar interbody fusion.
abstract: Retrospective radiographic analysis.To determine the fusion rate of stand-alone lateral lumbar interbody fusion (LLIF). Biomechanical studies have indicated that LLIF may be more stable than anterior or transforaminal lumbar interbody fusion. Early clinical reports of stand-alone LLIF have shown success in obtaining fusion and indirectly decompressing nerve roots. A consecutive case series of stand-alone LLIF was analyzed with chart and radiographic review. Non-union was determined by symptomatology consistent with non-union and absence of bridging bone on the CT scan. Thirty-nine levels of stand alone LLIF were performed in 23 patients. Eleven patients received 1-level surgery, 7 patients received 2-level surgery, 3 patients received 3-level surgery, and 1 patient received 4-level surgery. Excluding 1 infected case, we analyzed 37 levels of stand alone LLIF in 22 patients. Non-union incidence was 7 levels in 6 patients. Non-union rate was 7/37 (19%) per level and 6/22 (27%) per patient. While our study population was relatively low, a non-union rate of 19% to 27% is concerning for modern spine surgery. Currently in our practice, we occasionally still perform stand-alone LLIF utilizing 22 mm wide grafts in low-demand levels in non-smoking and non-osteoporotic patients. However, in a majority of patients, we provide supplemental fixation: bilateral pedicle screws in most patients and unilateral pedicle screws or spinous process plates in some patients.
authors.affiliation: From the Marina Spine Center, Marina del Rey, CA (RW, RW-III); and University of Southern California, Los Angeles, CA (RH).
authors.forename: Robert
authors.initials: R
authors.lastname: Watkins
authors.forename: Robert
authors.initials: R
authors.lastname: Watkins
authors.forename: Robert
authors.initials: R
authors.lastname: Hanna
mesh_terms: D000368:Aged; D018786:Bone Substitutes; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016348:Osseointegration; D065289:Pedicle Screws; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D064232:Visual Analog Scale
chemical_list: D018786:Bone Substitutes