Mustfa Manzur1, Sohrab S Virk2, Bridget Jivanelli3, Avani S Vaishnav2, Steven J McAnany4, Todd J Albert4, Sravisht Iyer4, Catherine Himo Gang2, Sheeraz Qureshi5. 1. Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA. 2. Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA. 3. The Kim Barrett Memorial Library, Hospital for Special Surgery, New York, NY 10021, USA. 4. Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. 5. Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. Electronic address: qureshis@hss.edu.
Abstract
BACKGROUND: Anterior lumbar interbody fusion (ALIF) has been used for treatment of a variety of spinal conditions including degenerative disc disorders and low-grade spondylolisthesis. Expected fusion rate of stand-alone ALIF constructs is currently unclear. The aim of this study was to examine the fusion rate for ALIF without supplemental posterior fusion or instrumentation (stand-alone ALIF). METHODS: We queried the MEDLINE, COCHRANE, and EMBASE databases for all literature related to spine fusion rates using a stand-alone ALIF procedure with a publication cutoff date of July 19, 2018. Supplementary combinations of search terms included spine, fusion, fixation, rate(s), and arthrodesis. ALIF surgery was considered stand-alone when not paired with supplemental posterior fusion or posterior spinal instrumentation. Nonhuman and non-English publications were excluded. Cohort fusion rate differences were calculated using Student t test with significance assigned if p value was less than .05. RESULTS: Title and abstract level review required assessing 840 unique publications. Across the 55 studies that met the inclusion criteria of this systematic review, 5,517 patients and 6,303 vertebral levels were fused. The overall weighted average patient fusion rate following stand-alone ALIF was 88.2% (range: 16.6%-100%). In the 31 studies with at least 50 subjects, the weighted average fusion rate following stand-alone ALIF was 88.6% (range: 57.5%-99.0%). Use of anterior fixation plate devices yielded a fusion rate of 94.2%. Newer zero-profile interbody implants had a fusion rate of 89.2%. Fusion rates were lower in studies with 50% or more subjects having positive smoking and worker's compensation status, however these results were found to be statistically insignificant (p>.05). Fusion rate for subjects in the eight rhBMP-2 study groups was 94.4% (n=889) compared with 84.8% (n=3,102) in 38 study groups without rhBMP-2 used. CONCLUSIONS: Based on the available data, stand-alone ALIF procedures yield high fusion rates overall. Fusion failure and pseudoarthrosis rates are higher in study populations involving a high percentage of smokers or positive workers compensation status. Allograft utilization does not significantly improve fusion rate when compared with autograft in stand-alone ALIF constructs.
BACKGROUND: Anterior lumbar interbody fusion (ALIF) has been used for treatment of a variety of spinal conditions including degenerative disc disorders and low-grade spondylolisthesis. Expected fusion rate of stand-alone ALIF constructs is currently unclear. The aim of this study was to examine the fusion rate for ALIF without supplemental posterior fusion or instrumentation (stand-alone ALIF). METHODS: We queried the MEDLINE, COCHRANE, and EMBASE databases for all literature related to spine fusion rates using a stand-alone ALIF procedure with a publication cutoff date of July 19, 2018. Supplementary combinations of search terms included spine, fusion, fixation, rate(s), and arthrodesis. ALIF surgery was considered stand-alone when not paired with supplemental posterior fusion or posterior spinal instrumentation. Nonhuman and non-English publications were excluded. Cohort fusion rate differences were calculated using Student t test with significance assigned if p value was less than .05. RESULTS: Title and abstract level review required assessing 840 unique publications. Across the 55 studies that met the inclusion criteria of this systematic review, 5,517 patients and 6,303 vertebral levels were fused. The overall weighted average patient fusion rate following stand-alone ALIF was 88.2% (range: 16.6%-100%). In the 31 studies with at least 50 subjects, the weighted average fusion rate following stand-alone ALIF was 88.6% (range: 57.5%-99.0%). Use of anterior fixation plate devices yielded a fusion rate of 94.2%. Newer zero-profile interbody implants had a fusion rate of 89.2%. Fusion rates were lower in studies with 50% or more subjects having positive smoking and worker's compensation status, however these results were found to be statistically insignificant (p>.05). Fusion rate for subjects in the eight rhBMP-2 study groups was 94.4% (n=889) compared with 84.8% (n=3,102) in 38 study groups without rhBMP-2 used. CONCLUSIONS: Based on the available data, stand-alone ALIF procedures yield high fusion rates overall. Fusion failure and pseudoarthrosis rates are higher in study populations involving a high percentage of smokers or positive workers compensation status. Allograft utilization does not significantly improve fusion rate when compared with autograft in stand-alone ALIF constructs.
Authors: Benjamin Chatterjee; Michael Rauschmann; Christoph Fleege; Mohammad Arabmotlagh; Sven Schmidt; Kimberly Martin; Marcus Rickert Journal: Int J Spine Surg Date: 2020-12-29
Authors: Syed I Khalid; Ravi S Nunna; Rachyl M Shanker; Kyle B Thomson; Rown Parola; Owoicho Adogwa; Ankit I Mehta Journal: Int J Spine Surg Date: 2022-06-14
Authors: Seth Ahlquist; Rachel Thommen; Howard Y Park; William Sheppard; Kevin James; Elizabeth Lord; Arya N Shamie; Don Y Park Journal: J Spine Surg Date: 2020-12
Authors: Laura C Shum; Alex M Hollenberg; Avionna L Baldwin; Brianna H Kalicharan; Noorullah Maqsoodi; Paul T Rubery; Addisu Mesfin; Roman A Eliseev Journal: PLoS One Date: 2020-11-09 Impact factor: 3.240
Authors: Arjan C Y Loenen; Jérôme Noailly; Keita Ito; Paul C Willems; Jacobus J Arts; Bert van Rietbergen Journal: Front Bioeng Biotechnol Date: 2022-01-11
Authors: Ravi S Nunna; Philip B Ostrov; Darius Ansari; Joseph R Dettori; Periklis Godolias; Elias Elias; Angela Tran; Rod J Oskouian; Robert Hart; Amir Abdul-Jabbar; Keith L Jackson; John G Devine; Ankit I Mehta; Owoicho Adogwa; Jens R Chapman Journal: Global Spine J Date: 2021-09-28
Authors: Milan Krticka; Ladislav Planka; Lucy Vojtova; Vladimir Nekuda; Premysl Stastny; Radek Sedlacek; Adam Brinek; Michaela Kavkova; Eduard Gopfert; Vera Hedvicakova; Michala Rampichova; Leos Kren; Kvetoslava Liskova; Daniel Ira; Jana Dorazilová; Tomas Suchy; Tomas Zikmund; Jozef Kaiser; David Stary; Martin Faldyna; Martin Trunec Journal: Biomedicines Date: 2021-06-25