Our Summary

This research paper is about a study that investigates whether a certain technique - using specially designed cages during anterior lumbar interbody fusion (ALIF) - can help correct spinal deformities and conditions in patients who previously had unsuccessful back surgery. In simpler terms, it’s about a possible way to fix back problems by operating from the front of the body, even if previous surgery from the back didn’t work.

The study involved 20 patients, who were divided into two groups based on the extent of their previous back instrumentation and fusion. The researchers used these specially designed cages with different angles, then removed old back instrumentation and put new ones in place.

The results suggest this technique can indeed help correct spinal issues, with the degree of correction roughly half of the angle built into the cage. This means the greater the angle of the cage, the greater the correction achieved.

Also, the technique seems to work equally well whether or not the patient had a condition called pseudarthrosis (a type of non-healing after a fracture or fusion surgery).

There were a few complications, mostly related to the front surgery, but no neurological or blood vessel injuries.

The researchers conclude that this technique could be a good option for correcting spinal deformities from the front, especially in patients with pseudarthrosis from previous back surgery. However, it’s crucial to carefully select the levels for the operation to ensure safety and effectiveness.

FAQs

  1. What is the main aim of the study conducted on using cages during anterior lumbar interbody fusion (ALIF)?
  2. What were the key findings of the study related to correcting spinal deformities?
  3. Can this technique be used for patients with pseudarthrosis, and how effective is it?

Doctor’s Tip

A doctor might advise a patient undergoing lumbar fusion to carefully follow post-operative instructions, including proper lifting techniques, maintaining a healthy weight, and participating in physical therapy to aid in recovery and prevent future complications. It is also important to communicate any changes or concerns to their healthcare provider promptly.

Suitable For

Patients who are typically recommended lumbar fusion include those with:

  1. Degenerative disc disease: When the discs between the vertebrae in the spine start to break down, causing pain and instability.

  2. Spondylolisthesis: When one vertebra slips forward over the one below it, causing nerve compression and pain.

  3. Spinal stenosis: When the spinal canal narrows, putting pressure on the spinal cord and nerves.

  4. Herniated discs: When the gel-like center of a disc bulges out, putting pressure on nearby nerves.

  5. Spinal fractures: From trauma or osteoporosis, causing instability and pain.

  6. Failed back surgery: When a previous back surgery did not provide relief or resulted in complications.

Overall, patients who have not responded to conservative treatments such as physical therapy, medications, and injections may be recommended for lumbar fusion surgery. It is important for patients to discuss their specific condition and treatment options with their healthcare provider to determine if lumbar fusion is the best course of action for them.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain, leg pain, weakness, or numbness due to spinal deformities or conditions.
  2. Patient undergoes various conservative treatments such as physical therapy, medication, and injections to manage symptoms.
  3. If conservative treatments are unsuccessful, patient may undergo previous back surgery with instrumentation and fusion.
  4. Patient continues to experience persistent symptoms and possibly develops complications or pseudarthrosis.

After lumbar fusion with specially designed cages during ALIF:

  1. Patient is selected for the study based on previous back instrumentation and fusion.
  2. Patient undergoes surgery using specially designed cages with different angles to correct spinal deformities.
  3. Old back instrumentation is removed and new instrumentation is placed in the front of the body.
  4. Degree of correction achieved is roughly half of the angle built into the cage, with greater angles leading to greater correction.
  5. Technique shows promising results in correcting spinal issues, regardless of pseudarthrosis.
  6. Some complications related to the front surgery are reported, but no neurological or blood vessel injuries occur.
  7. Researchers conclude that this technique could be a viable option for correcting spinal deformities, especially in patients with pseudarthrosis from previous back surgery, with careful selection of levels for the operation.

What to Ask Your Doctor

  1. What is anterior lumbar interbody fusion (ALIF) and how does it differ from traditional back surgery techniques?
  2. How do specially designed cages used in ALIF help correct spinal deformities and conditions?
  3. What are the potential benefits of using this technique for patients who have had unsuccessful back surgery in the past?
  4. Are there any specific criteria or factors that make a patient a good candidate for ALIF with specially designed cages?
  5. What are the potential risks or complications associated with this procedure?
  6. How long is the recovery process after ALIF with specially designed cages, and what can patients expect in terms of pain management and rehabilitation?
  7. Will additional follow-up surgeries or treatments be necessary after undergoing ALIF with specially designed cages?
  8. Are there any alternative treatments or procedures that could be considered for correcting spinal deformities if ALIF is not recommended or successful?
  9. How long has this technique been used in clinical practice, and what is the long-term success rate for patients who undergo ALIF with specially designed cages?
  10. Are there any ongoing research studies or advancements in this field that could potentially improve outcomes for patients with spinal deformities?

Reference

Authors: Kadam A, Wigner N, Saville P, Arlet V. Journal: J Neurosurg Spine. 2017 Dec;27(6):650-660. doi: 10.3171/2017.5.SPINE16926. Epub 2017 Sep 29. PMID: 28960160