The indications for interbody fusion cages in the treatment of spondylolisthesis

Analysis of 120 cases

Paul C. McAfee, John Glenden DeVine, Christopher D. Chaput, Brad G. Prybis, Ira L. Fedder, Bryan W. Cunningham, Dennis J. Farrell, Samuel J. Hess, Franco E. Vigna

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Study Design. This study retrospectively examines outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior carbon fiber cages and 360° fusion in spondylolisthesis. Objectives. The goals were to examine the outcomes and perioperative complications of using anterior column support in the treatment of various types of spondylolisthesis. Summary of Background Data. In 2000, Brantigan et al reported the Brantigan interbody fusion cage used as a posterior lumbar interbody fusion in the US IDE clinical trial. This is the largest series to date of TLIF cages specifically used in the treatment of spondylolisthesis. Methods. A comprehensive long-term follow-up study was conducted to evaluate the fusion success and morbidity following implantation with an anterior column support and posterior pedicle screw fixation. The 120 patients with spondylolisthesis were comprised by 11 cases, dysplastic; 58 cases, degenerative; and 51 cases, isthmic-acquired spondylolisthesis. Anterior column support was either a rectangular carbon fiber/PEEK device or a cylindrical carbon fiber/PEEK device. Twenty-eight cases (23%) were revisions. Results. There were no pseudarthrosis, instrumentation failures, or significant subsidence at the TLIF level. The disc space height and foraminal height were restored as part of the surgical procedure. Disc height, as measured from the posterior edge of the superior vertebral body, increased from a mean of 5.6 mm before surgery to a mean of 9.3 mm after surgery. Although reduction of the slip was not the primary goal during the surgical procedure for the 120 cases with spondylolisthesis (isthmic-acquired = 51, degenerative = 58, and dysplastic = 11), the 23% slip reduction achieved at surgery was maintained at follow-up. Mean operative time was 143 ± 33 minutes (range, 70-255 minutes) for all cases. Mean blood loss was 724 ± 431 mL (range, 300-2,500 mL). There were seven incidental durotomies and three infections. One patient with Grade I degenerative spondylolisthesis required revision of the carbon fiber cage for posterior migration secondary to a traumatic event 3 months after surgery. Fusion success was 98% using the criteriaof Lenke for the posterior fusion and Brantigan and Steffee for the TLIF graft incorporation. Conclusions. Interbody cages in spondylolisthesis are useful to increase neuroforaminal height, to facilitate reduction, and to improve the chances of achieving a successful 360° fusion.

Original languageEnglish (US)
JournalSpine
Volume30
Issue number6 SPEC. ISS.
StatePublished - Mar 1 2005
Externally publishedYes

Fingerprint

Spondylolisthesis
Therapeutics
Equipment and Supplies
Pseudarthrosis
Operative Time
Clinical Trials
Morbidity
Transplants
carbon fiber

Keywords

  • Conventional dual cages
  • Lumbar degenerative instability
  • Pedicle instrumentation
  • Post-laminectomy syndrome
  • Spondylolisthesis

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

McAfee, P. C., DeVine, J. G., Chaput, C. D., Prybis, B. G., Fedder, I. L., Cunningham, B. W., ... Vigna, F. E. (2005). The indications for interbody fusion cages in the treatment of spondylolisthesis: Analysis of 120 cases. Spine, 30(6 SPEC. ISS.).

The indications for interbody fusion cages in the treatment of spondylolisthesis : Analysis of 120 cases. / McAfee, Paul C.; DeVine, John Glenden; Chaput, Christopher D.; Prybis, Brad G.; Fedder, Ira L.; Cunningham, Bryan W.; Farrell, Dennis J.; Hess, Samuel J.; Vigna, Franco E.

In: Spine, Vol. 30, No. 6 SPEC. ISS., 01.03.2005.

Research output: Contribution to journalArticle

McAfee, PC, DeVine, JG, Chaput, CD, Prybis, BG, Fedder, IL, Cunningham, BW, Farrell, DJ, Hess, SJ & Vigna, FE 2005, 'The indications for interbody fusion cages in the treatment of spondylolisthesis: Analysis of 120 cases', Spine, vol. 30, no. 6 SPEC. ISS..
McAfee PC, DeVine JG, Chaput CD, Prybis BG, Fedder IL, Cunningham BW et al. The indications for interbody fusion cages in the treatment of spondylolisthesis: Analysis of 120 cases. Spine. 2005 Mar 1;30(6 SPEC. ISS.).
McAfee, Paul C. ; DeVine, John Glenden ; Chaput, Christopher D. ; Prybis, Brad G. ; Fedder, Ira L. ; Cunningham, Bryan W. ; Farrell, Dennis J. ; Hess, Samuel J. ; Vigna, Franco E. / The indications for interbody fusion cages in the treatment of spondylolisthesis : Analysis of 120 cases. In: Spine. 2005 ; Vol. 30, No. 6 SPEC. ISS.
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T2 - Analysis of 120 cases

AU - McAfee, Paul C.

AU - DeVine, John Glenden

AU - Chaput, Christopher D.

AU - Prybis, Brad G.

AU - Fedder, Ira L.

AU - Cunningham, Bryan W.

AU - Farrell, Dennis J.

AU - Hess, Samuel J.

AU - Vigna, Franco E.

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N2 - Study Design. This study retrospectively examines outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior carbon fiber cages and 360° fusion in spondylolisthesis. Objectives. The goals were to examine the outcomes and perioperative complications of using anterior column support in the treatment of various types of spondylolisthesis. Summary of Background Data. In 2000, Brantigan et al reported the Brantigan interbody fusion cage used as a posterior lumbar interbody fusion in the US IDE clinical trial. This is the largest series to date of TLIF cages specifically used in the treatment of spondylolisthesis. Methods. A comprehensive long-term follow-up study was conducted to evaluate the fusion success and morbidity following implantation with an anterior column support and posterior pedicle screw fixation. The 120 patients with spondylolisthesis were comprised by 11 cases, dysplastic; 58 cases, degenerative; and 51 cases, isthmic-acquired spondylolisthesis. Anterior column support was either a rectangular carbon fiber/PEEK device or a cylindrical carbon fiber/PEEK device. Twenty-eight cases (23%) were revisions. Results. There were no pseudarthrosis, instrumentation failures, or significant subsidence at the TLIF level. The disc space height and foraminal height were restored as part of the surgical procedure. Disc height, as measured from the posterior edge of the superior vertebral body, increased from a mean of 5.6 mm before surgery to a mean of 9.3 mm after surgery. Although reduction of the slip was not the primary goal during the surgical procedure for the 120 cases with spondylolisthesis (isthmic-acquired = 51, degenerative = 58, and dysplastic = 11), the 23% slip reduction achieved at surgery was maintained at follow-up. Mean operative time was 143 ± 33 minutes (range, 70-255 minutes) for all cases. Mean blood loss was 724 ± 431 mL (range, 300-2,500 mL). There were seven incidental durotomies and three infections. One patient with Grade I degenerative spondylolisthesis required revision of the carbon fiber cage for posterior migration secondary to a traumatic event 3 months after surgery. Fusion success was 98% using the criteriaof Lenke for the posterior fusion and Brantigan and Steffee for the TLIF graft incorporation. Conclusions. Interbody cages in spondylolisthesis are useful to increase neuroforaminal height, to facilitate reduction, and to improve the chances of achieving a successful 360° fusion.

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KW - Conventional dual cages

KW - Lumbar degenerative instability

KW - Pedicle instrumentation

KW - Post-laminectomy syndrome

KW - Spondylolisthesis

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