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2014년 7월 16일 수요일

Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results With a Two Year Follow Up

Brief review

SPINE지의 최신호에 나온 논문 입니다.
퇴행성 디스크 질환이 있는 환자들에게 stand alone 전방경유요추체간 유합술을 시행한 후 2년이 지난 후의 임상적, 방사선학적 결과를 관찰한 연구 입니다.
허리,다리의 통증지수(VAS) 및 일상생활장애지수(ODI) 가 수술전에 비해 유의하게 감소하였고, 인접분절의 disc height도 감소되지 않는 좋은 결과가 나왔네요.
아래의 링크로 들어가서 한번 읽어보세요^^ 시간 없으시면 아래의 key points만 읽어봐도 도움이 될 듯 합니다.

*Title: Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results With a Two Year Follow Up.
*Authors: Lammli J, Whitaker C, Moskowitz A, Duong J, Dong F, Felts L, Konye G, Ablah E, Wooley P.
*Bibliography: Spine (Phila Pa 1976). 2014 May 12. [Epub ahead of print]

Study Design
Retrospective chart review

To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand alone Anterior Lumbar Interbody Fusion (ALIF, either one or two-level) and use of rhBMP-2 for bony fusion with instrumented fixation.

Summary of Background Data
Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion (PSF), and total disc replacement (TDR). Currently, there has been paucity in the literature on the evaluation of ALIFs.

Researchers reviewed a consecutive series of patients with DDD that had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of rhBMP-2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported.

Patients' two year Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores significantly improved from pre-surgery (p ≤ 0.0001). Patients' two year post-operative disc height was significantly greater than the pre-operative disc height at the fused level (p ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intra-operative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360 fusions and TDR.


Stand alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at two years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level.