[Anterior lumbar interbody fusion with self-locked cage for treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability].

OBJECTIVE: To evaluate the effectiveness of anterior lumbar interbody fusion (ALIF) with self-locked Cage in the treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability.

METHODS: Between March 2010 and February 2012, 31 patients with central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability were treated with decompression and ALIF assisted by self-locked Cage through the mini-incision and retroperitoneal approach. There were 20 males and 11 females with the mean age of 46 years (range, 34-58 years). And the disease duration ranged from 5 to 32 months (mean, 16 months). The lesion located at the L3,4 level in 2 cases, L4,5 in 20 cases, and L5, S1 in 9 cases. The operation time, intraoperative blood loss, bedridden time, hospitalization time, and complications were recorded. The effectiveness was evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). Lumbar X-ray films and three-dimensional CT scan were taken to evaluate the fusion and the variation of the height and Cobb angle of intervertebral space.

RESULTS: The mean operation time was 102 minutes; the mean intraoperative blood loss was 121 mL; the mean bedridden time was 5 days; and the mean hospitalization time was 11 days. Intraoperative peritoneum tear and ascending lumbar vein tear, postoperative cerebrospinal fluid leakage, pain at donor site, and asymmetric elevated skin temperature of the lower extremity occurred in 2 cases, 1 case, 1 case, 4 cases, and 2 cases respectively, which were relieved after symptomatic treatment. All cases were followed up 12-28 months (mean, 20 months). No infection, recurrence, deep venous thrombosis, or retrograde ejaculation was observed after operation. MRI showed complete decompression at 3 months after operation. At last follow-up, the scores of ODI, VAS of lumbars and lower limbs, the intervertebral height, and Cobb angle were significantly improved when compared with preoperative ones (P < 0.05); CT scan showed bone fusion in all cases.

CONCLUSION: The clinical outcome of ALIF with self-locked Cage through mini-incision and retroperitoneal approach is satisfactory in treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. It can retain the posterior spinal construction and has the advantages of less trauma and bleeding, immediate stability, high bone fusion rate, and so on.