The Role of Anterior Lumbar Fusion for Internal Disc Disruption

Blumenthal, Scott L.; Baker, John E.; Dossett, Andrew; Selby, David K.

doi:10.1097/00007632-198805000-00023

Cited by 195 publications

(54 citation statements)

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“…Some authors advocate an anterior procedure for patients in w h o m posterolateral fusion surgery has failed; others advocate an anterior or combined anterior and posterior fusion as the index procedure [3,17,22]. The choice between an anterior or posterior primary fusion for degenerative disc disease is usually based upon opinion rather than on science.…”

Section: Introductionmentioning

confidence: 99%

Vertebral body MRI related to lumbar fusion results

et al. 1997

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The evaluation of continued pain after a technically successful posterolateral lumbar spine fusion is often challenging. Although the intervertebral disc is often a source of low back pain, abnormal endplates may also be a focus of pain, and possibly a source of continued pain after a posterolateral fusion. MRI allows noninvasive evaluation for disc degeneration, as well as for abnormal endplates and adjacent vertebral body marrow. Previous studies have found inflammatory marrow changes, adjacent to abnormal endplates, associated with disc degeneration in low back pain patients. In this study, preoperative MRI scans in 89 posterolateral lumbar fusion patients were reviewed, by an independent radiologist, to determine whether vertebral body marrow changes adjacent to the endplates were related to contined pain. Independent chart review and follow-up telephone interview of all patients at a 4-year follow-up (mean) formed the basis for the clinical results. Vertebral body MRI signals consistent with inflammatory or fatty changes were found in 38% of patients, and always occurred adjacent to a degenerated disc. Inflammatory MRI vertebral body changes were significantly related to continued low back pain at P = 0.03. We conclude that posterolateral lumbar fusion has a less predictable result for the subset of degenerative disc patients with abnormal endplates and associated marrow inflammation. More research is needed to determine the biological and biomechanical effects of a posterolateral fusion upon the endplate within the fused segments. If indeed further study supports the hypothesis that abnormal endplates associated with inflammation are a source of pain, then treating the endplates directly by anterior fusion may be a preferred treatment for this subset of degenerative patients.

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Section: Introductionmentioning

confidence: 99%

Vertebral body MRI related to lumbar fusion results

et al. 1997

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“…An improvement of 77.8% (Oswestry Index) for anterior lumbar interbody fusion supplemented with the Hartshill horseshoe cage is a better result than was achieved in several of the series reported in literature [1,3,15,23,25,26,27]. The clinical success rate in these studies was at best 74% subjective and 68% objective improvement.…”

Section: Discussionmentioning

confidence: 77%

Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage

Madan¹,

Boeree²

2003

Eur Spine J

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“…), the PLIF surgical technique was improved in the 1980s, and new implants constructed of various materials were developed (Bienik and Swiecki, 1991;Brantigan et al, 1994; Khoo et al, 2002;Šrámek et al, 2010). Likewise, novel diagnostic tools have been developed including MRI, 3D CT, SPECT-CT (Crock, 1976, Modic et al, 1988Blumenthal et al, 1988), and new materials (e.g., ceramic, titanium, PEEK) have yielded new types of implants leading to the modernization of the interbody fusion via PLIF techniques (Alexander et Kokubo, 1990;Yamamuro, 1995;Hashimoto et al, 2002;Thalgott et al, 2002;Sandhu, 2003). Currently, the majority of implants for PLIF consist of two separate components, including the solid cage shape and osseoconductive material (i.e., TCP, BMP) that ensures osteoblastic activity and the interbody fusion formation.…”

Section: Introductionmentioning

confidence: 99%