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Outcomes Studied in Spinal Fusion With Anterior Support

Study fails to find clear reason for superior patient outcomes with anterior support versus without it

FRIDAY, Nov. 5 (HealthDay News) -- While research has shown that providing anterior column support in lumbar spinal fusion delivers superior long-term patient outcomes, this can't be positively credited to reduced adjacent segment degeneration (ASD), according to research published in the Oct. 15 issue of Spine.

Tina S. Videbaek, M.D., of the Aarhus University Hospital in Denmark, and colleagues conducted a long-term follow-up of outcomes for 95 patients with severe chronic low back pain who, during 1996 to 1999, were randomized to either anterior lumbar interbody fusion combined with posterolateral lumbar fusion (ALIF+PLF), which provides column anterior support, or to PLF alone, which does not. In the follow-up, the patients underwent magnetic resonance imaging to discover factors that might explain the apparent ALIF+PLF outcome advantage. In particular, the study looked at long-term differences in ASD.

The researchers found that ASD results for the first to third adjacent levels were similar between the ALIF+PLF and PLF-only groups. Disc degeneration and dorsal disc herniation were frequent and were more pronounced at the first adjacent level than at the second and third adjacent levels. Also, end-plate changes were seen in 26 percent of patients.

"We conclude that the degree of ASD at long-term follow-up was similar in the randomization groups. The cause of the superior outcome in the group with anterior support is still unclear," the authors write.

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