Anterior Column Support With Anterior Lumbar Interbody Fusion Cage Through Posterior Approach Maneuver: A Technical Note and Preliminary Radiologic Report.

Abstract

Retrospective cohort study. To evaluate the feasibility of anterior column support through a posterior approach using an anterior lumbar interbody fusion (ALIF) cage. Anterior fusion is an effective way to maintain spinal lordosis; however, it may be technically difficult in some cases. Conventional lumbar fusion and spinal deformity correction surgeries were performed using a conventional ALIF cage with a modified extratransforaminal lumbar interbody fusion (ExTLIF). Patients with 1 or 2 fusion levels were classified into group 1, and those with spinal deformity correction were classified into group 2. Radiologic parameters were evaluated during the follow-up periods. A total of 51 patients underwent this procedure. Thirty-five patients (19 male and 16 female, 69.4±9.6 y old) with 37 fusion sites were in group 1, and 16 patients (3 male and 13 female, 71.4±5.7 y old) were in group 2. The mean follow-up periods of groups 1 and 2 were 12.3±3.4 and 10.7±4.7 months, respectively. In group 1, the mean lumbar lordosis and segmental lumbar lordosis increased significantly during the last follow-up (39.9±13.0 and 20.6±6.0 degrees, respectively, both P <0.001), and the mean disc space also increased at the last follow-up ( P <0.001). The same was observed in group 2 with significant increases in the mean lumbar lordosis and segmental lumbar lordosis at the last of the follow-up period (46.8±9.3 and 16.9±8.9 degrees, respectively, both P <0.001). The disc space also increased significantly ( P <0.001). Fusion rates were 94.2% and 87.5% in groups 1 and 2, respectively, and the corresponding subsidence rates were 85.4% and 68.8%. In group 1, there was a significant correlation between subsidence and cage height ( P =0.046). This procedure (ExTLIF) can be applied in cases where an anterior approach is contraindicated as well as for deformity correction. Level III.