Coblation of spinal endplates in preparation for interbody spinal fusion

Posterior lumbar interbody fusion (PLIF) and anterior lumbar interbody fusion (ALIF) have become routine alternatives to intertransverse process fusion. The use of Coblation (ArthroCare Corporation, Sunnyvale, CA) allows for routine and reproducible removal of cartilaginous endplate down to the bony endplate. Our experience with this new technology is reviewed. The authors used Coblation to prepare endplates of 10 consecutive patients undergoing interbody fusion. The results were compared to the following 10 consecutive patients undergoing interbody fusion with endplates prepared in the standard fashion with curettes and rongeurs. The same interbody grafts and instrumentation were used in all patients. Follow-up X-rays were done at 1 week, 6 weeks, 6 months, 1 year, and then each year thereafter. The 20 patients were reviewed along with their films. In each patient the disk spaces and the ALIF/PLIF cages appeared to be fused by 6 months. There was one superficial wound infection in each group. In each of the cases in which PLIF was performed, the cages were augmented by posterior lateral graft and pedicle screw fixation. All patients in both groups reported improvement in pain and/or neurologic symptoms by 6 months. The patients were followed for 4.6 years in the Coblation group and 4.1 years in the standard group. Disk space height was measured in all patients at 6 months. In the Coblation group, average disk space height was 9.0 mm compared to 8.2 mm in the standard group (p<0.1). We feel that the maintenance of normal structures within the lumbar spine with anterior/posterior lumbar interbody fusions and non-mechanical means of preparing the endplates are advantageous. Clearly, the number of patients involved and the length of follow-up limit this study, but it serves as an early indicator that endplate preparation may play a role in graft subsidence and fusion rates. Additional study is warranted.