Anterior Lumbar Interbody Fusion for Focal Type of Degenerative Flat Back: Preliminary Report.

Shim, Chan Shik; Lee, Sang Ho; Lim, Sang Rak; Jung, Byung Ju; Choi, Won Chul; Chung, Sang Ki

Original Article

Journal of Korean Neurosurgical Society 2003;33(5): 460-465.

Chan Shik Shim, Sang Ho Lee, Sang Rak Lim, Byung Ju Jung, Won Chul Choi, Sang Ki Chung

¹Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea. shimcs@wooridul.co.kr
²Department of General Surgery, Wooridul Spine Hospital, Seoul, Korea.

ABSTRACT

OBJECTIVE
The purpose of this study is to determine the efficacy of anterior lumbar interbody fusion(ALIF) for the patients with focal type of degenerative flat back. METHODS: The authors reviewed clinical and radiologic data of 16 patients with focal type of degenerative flat back who underwent ALIF during the period between December 1999 and November 2000. The operation procedure was ALIF using titanium or carbon fiber cages of lordotic angle, which were filled with allograft or autograft mixed with allograft through minilaparotomy. RESULTS: The majority of the patients were female(15 female: 1 male) and the mean age was 60.1 years. Six patients were operated on one level, ten on two levels. The mean follow up period was 10.7 months. The mean operation time was 131minutes and the average estimated blood loss was 133ml. Transfusion was not needed in any case. The mean preoperative lumbar lordotic angle was 4.1 degree(-7.4-41.6) and improved to 17.5 degree(-4.5-41.9) postoperatively. Radiological fusion was achieved in 13 patients(81%). The Oswestry disability index score improved from 62.5% to 23.9% and the patient's subjective improvement rate was 80%. Complications were infection in one patient, incisional hernia in one, symptomatic pseudoarthrosis in one and transient sympathetic disturbance in left leg in three.
CONCLUSION
In a subset of the patients with degenerative flat back who showed disc degeneration in one or two levels, ALIF using cages improved patient's symptoms effectively. It seems that ALIF through minilaparotomy can be one of the surgical options in the treatment of the focal type of degenerative flat back.

Key Words: Anterior lumbar interbody fusion; Degenerative disc disease; Degenerative flat back