Intervertebral fixation: clinical results with anterior cages

Anterior lumbar interbody fusion has several clinical advantages over posterior or posterolateral lumbar fusion. Interbody fusion procedures place bone grafts within the disc space at the center of rotation of the vertebral motion segment. The intervertebral area is highly vascular, and the grafts have a wide contact area in the weight-bearing axis of the spinal motion segment. The high rates of fusion associated with the use of the threaded intervertebral fusion cages may be attributed, in part, to the following: (1) removal of the cartilagenous end plates and exposure of bleeding cancellous bony surfaces, (2) reestablishment of anatomic intradiscal height and tensioning of the annulus and ligamentous structures around the disc space, (3) use of appropriately sized implants to engage the peripheral apophysis of the vertebral end plates, and (4) use of autogenous grafts. Threaded interbody constructs provide adequate strength to ensure that no plastic deformation occurs within the maximum physiologic range. Dynamic testing of these implants also has shown that these implants are able to resist cyclic fatigue within typical normal daily physiologic loading. Stability testing has shown that when inserted anteriorly, these devices reduce intervertebral motion and increase spinal stiffness.