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Early outcomes after ALIF with cage and plate in discogenic low back pain: a quantitative analysis

Premiers résultats après ALIF par cage et plaque dans les lombalgies d'origine discale

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Though the anterior lumbar interbody fusion with cages is an interesting option in the treatment of discogenic low back pain, cage-related complications opened the way to alternative options like circumferential fusion or recent ALIF techniques using cages and anterior instrumentation. As the latter are rather recent, the aim of this prospective study was to quantitatively evaluate the early outcomes after ALIF with anterior cage and plate construct.

Methods

Pre- and postoperative data of 41 patients (mean age 42 years) were analyzed from a clinical, socio-professional, quality of life and biomechanical point of view, with a mean follow-up of 1.8 years. Evaluation was based on clinical data, four scores (SF-12, JOA, VAS, patient satisfaction index) and several radiological parameters (describing spine geometry and balance) for an accurate outcome assessment.

Results

In 1 and 2 years follow-up exams, good and excellent outcomes were found in 92% of cases, associated with high levels of quality of life (83%) and satisfaction (95%), but also with a late return to work (40% at 1 year and 76% at 2 years). Outcome was not related to postoperative disc narrowing, observed in 15% of patients. Radiological parameters values highlighted normal spine geometry and balance in 71% of cases and were postoperatively constant in most patients.

Conclusion

From a clinical and functional point of view, the early outcomes after ALIF with cage and plate were in agreement with success ranges in the literature; they were completed by good levels of quality of life and patient’s satisfaction. In addition to subsidence detection, biomechanical analysis offered a detailed insight into the evolution of the treated segment and on its impact on spine’s stability and balance.

Résumé

Contexte

L’arthrodèse lombaire intersomatique antérieure (ALIA) avec cages représente une option intéressante dans le traitement des lombalgies discogéniques; toutefois, les complications liées aux cages ont conduit au développement des options alternatives comme la fusion circonférentielle ou des techniques récentes d’ALIA avec cages et instrumentation antérieure. Les dernières techniques étant relativement récentes, l’objectif de notre étude prospective a été une évaluation quantitative des résultats après ALIA avec cage et plaque antérieure.

Méthodes

Les données pré- et postopératoires de 41 patients (âge moyen 42 ans) ont été analysées d’un point de vue clinique, socioprofessionnel, qualité de vie et biomécanique, avec un recul moyen de 1.8 ans. Afin d’obtenir une évaluation précise des résultats, notre analyse a été basée sur les données cliniques, quatre scores (SF-12, JOA, EVA, indice de satisfaction) et plusieurs paramètres radiologiques (décrivant la géométrie et l’équilibre du rachis).

Résultats

A court et moyen terme, les résultats ont été bons et excellents dans 92% des cas, associés à des bons niveaux de qualité de vie (83%) et de satisfaction (95%), mais aussi à un retour au travail tardif (40% à 1 an et 76% à 2 ans). Le résultat final ne semble pas lié au rétrécissement postopératoire de l’espace discal, observé dans 15% de patients. Les paramètres radiologiques, quasi-constants en postopératoire pour la plupart des cas, ont mis en évidence une géométrie et un équilibre rachidien normaux dans 71% des cas.

Conclusion

D’un point de vue clinique et fonctionnel, les résultats préliminaires de l’ALIA avec cage et plaque sont comparables aux taux de succès de la littérature; ils sont complétés par de bons niveaux de qualité de vie et de satisfaction du patient. Outre la détection de la subsidence, l’analyse biomécanique offre une vue détaillée sur l’évolution du segment traité et son impact sur la stabilité et l’équilibre du rachis entier.

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Acknowledgments

The authors wish to thank Maindron V, Mulsant P and Plantier S for their precious help in data collection and SpineNetwork for their support (grant for a PhD project ruled by the National Agency for Technological Research (ANRT in French): CIFRE no. 677/2002).

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Authors and Affiliations

  1. Laboratory of Biomechanics, ENSAM, 151 Bd de l’Hôpital, 75013, Paris, France

    S. Champain & W. Skalli

  2. Santy Orthopaedic Center, 24 Av Paul Santy, 69008, Lyon, France

    V. Fière

  3. Clinical Research Department, Scient’X, Guyancourt, France

    A. Mitulescu & P. Schmitt

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  1. S. Champain
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  2. V. Fière
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  3. A. Mitulescu
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  5. W. Skalli
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Corresponding author

Correspondence to S. Champain.

Appendices

Appendix 1

Table 4

Table 4 Scoring system of the JOA for low back pain (JOA score): 15-point system includes only subjective symptoms (9 points), objective findings (6 points) and urinary bladder function (−6 points) [42, 43]
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Appendix 2

Table 5

Table 5 Patient satisfaction index (PSI) [8], as used in the study
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Champain, S., Fière, V., Mitulescu, A. et al. Early outcomes after ALIF with cage and plate in discogenic low back pain: a quantitative analysis. Eur J Orthop Surg Traumatol 18, 177–188 (2008). https://doi.org/10.1007/s00590-007-0283-4

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