title: Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct.
abstract: In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation time, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and survivorship without the need for revision surgery. Telephone follow-ups were conducted to ascertain survivorship, clinical outcomes (VAS, ODI) and patient satisfaction. Operation time was longer in the hybrid group (p=0.021). The hybrid group showed a significant improvement in VAS and ODI with 52.2% and 50.0% improvement versus 28.3% and 25.5% in the ALIF group (p<0.05). At the telephone follow-up for patient satisfaction, 95.7% (n=22) of the hybrid group were satisfied and 95.2% (n=21) of the ALIF group were satisfied. Seventy-four percent (n=17) in the hybrid group and 85.7% (n=18) in the ALIF group would choose to do the initial surgery again. Kaplan-Meier analysis showed 80.5% survivorship for hybrids and 75.9% for ALIF at 5years. With our clinical outcomes in VAS and ODI scores, these results, when taken together, indicate that hybrid fusion is a valid and viable alternative to ALIF fusion, with at least equal if not better clinical outcomes in terms of survivorship, back pain, and disability scores.
authors.affiliation: MultiCare Orthopedics & Sports Medicine, Puyallup, WA, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Loma Linda University Medical Center, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA 92354, USA.
authors.forename: Yusuf T
authors.initials: YT
authors.lastname: Akpolat
authors.affiliation: Department of Pharmaceutical Science, School of Pharmacy, Loma Linda University, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Williams
authors.affiliation: Back and Sport Institute, Newport Beach, CA, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Bergey
authors.affiliation: Department of Orthopaedic Surgery, Loma Linda University Medical Center, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA 92354, USA. Electronic address: md4spine@yahoo.com.
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Cheng
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D059145:Total Disc Replacement / Q000009:adverse effects / Q000379:methods / Q000401:mortality
keywords: ALIF; Anterior lumbar interbody fusion; Hybrid construct; Multilevel lumbar degenerative disc disease; Total disc replacement