Degenerative conditions of the lumbar spine treated with intervertebral titanium cages and posterior instrumentation for circumferential fusion

Thirty-five consecutive patients were evaluated at an average followup time of 20 months after circumferential lumbar spinal fusion. All patients had degenerative conditions of the lumbar spine and same-day anterior spinal fu sion by using titanium cages packed with autograft bone and posterior instr umentation combined with a posterolateral autogenous bone graft. The purpos e of this study was to determine whether anterior titanium cage placement a nd posterior instrumentation with autologous bone graft was a safe and effi cacious procedure in patients with degenerative disease of the lumbar spine . Fusion rates, complications, pain relief, medication use, and work status were specifically analyzed. Although previous reports documented the use o f this technique for trauma and tumor cases, few studies assessed clinical and radiographic results in patients with degenerative conditions of the lu mbar spine. Plain radiographs were used to determine spinal fusion at each spinal level. All patients were administered preoperative and postoperative questionnaires regarding three specific clinical-outcome parameters. These consisted of pain level, medication use, and work status. Intraoperative a nd postoperative complications were also documented. Radiographic results s howed that 61 (97%) of 63 lumbar levels undergoing an arthrodesis procedure fused either anteriorly, posteriorly, or both. Of the 35 patients in this series, 33 (94%) fused at all levels, and two did not. Substantial pain rel ief was reported in 46% of all patients. Thirteen (37%) patients had one or more surgical complications. Circumferential spinal fusion in patients wit h degenerative etiologies yields excellent radiographic fusion rates and go od pain relief. The procedure is technically demanding and is associated wi th a high rate of complications.