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Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 15-25

Anterior versus posterior lumbar interbody fusion: Does cage geometry matter more than surgical approach?

1 Duke University Medical Center, Durham, NC, USA
2 Department of Orthopaedic Surgery, Beaumont Hospital, Detroit, MI, USA
3 University of Iowa Medical Center, Iowa City, IA, USA
4 Department of Orthopaedic Surgery, University of Kansas, Wichita, KS, USA

Correspondence Address:
Dr. Sergio A Mendoza-Lattes
Department of Orthopaedic Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27710
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DORJ.DORJ_3_19

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Background: For patients undergoing lumbar fusion, a variety of interbody arthrodesis techniques and devices exist, but few studies have evaluated the effect of cage geometry on radiographic outcomes. Thus, the purpose of this study is to compare the performance of expandable lordotic posterior lumbar interbody fusion (ePLIF) cages to lordotic anterior lumbar interbody fusion (ALIF) cages and to compare the early radiographic outcomes of different cage designs through review of the available literature. Materials and Methods: This is a retrospective case–control study, including 31 ePLIF and 36 ALIF levels, for the treatment of lumbar radiculopathy. Three-dimensional computed tomography scans were used to measure disc height, interbody angle, and foraminal height, both pre- and postoperatively. Implant geometry and positioning were then correlated with radiographic outcomes. The available ALIF and PLIF literature was then analyzed to determine the radiographic outcomes for each surgical technique based on cage geometry. Results: ePLIF cages increased foraminal height (P < 0.001), which was comparable to lordotic ALIF cages (P < 0.001). ePLIF and ALIF provided similar restoration of disc height; however, ALIF cages provided a significant increase in interbody angle (P < 0.001). Across the available literature, ALIF correlated with greater changes in interbody angle relative to PLIF regardless of cage geometry (lordotic vs. nonlordotic), while PLIF trended toward greater restoration of foraminal height. Conclusion: ePLIF cages are able to restore foraminal and disc height comparable to ALIF cages. However, lordotic ALIF cages should be utilized if sagittal restoration is a priority. Future studies are necessary to further explore the value of different implant design options. Level of Evidence: Level III. Clinical Relevance: Patients with abnormal sagittal balance should undergo a lordotic ALIF procedure. Patients who are sagittally balanced, however, can achieve fusion and decompression with either ALIF or ePLIF.

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