Non-union rate with stand-alone lateral lumbar interbody fusion

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 suc...

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Bibliographic Details
Published in:Medicine (Baltimore) 2014-12, Vol.93 (29), p.e275-e275
Main Authors: Watkins, 4th, Robert, Watkins, 3rd, Robert, Hanna, Robert
Format: Article
Language:English
Subjects:
Aged
Bone Substitutes
Humans
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Observational Study
Osseointegration
Pedicle Screws
Radiography
Retrospective Studies
Spinal Fusion - instrumentation
Spinal Fusion - methods
Visual Analog Scale
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Summary: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.
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000000275