Anterior lumbar fusion options. Technique and graft materials

The biomechanical requirements of the ideal lumbar interbody fusion are important in the surgical treatment of the vertebral endplates and graft selection. A series of 45 patients with anterior lumbar fusion were reviewed retrospectively. The fusion was performed with a composite construct consisting of femoral allograft cross-sections and allograft cancellous bone. Preparation of vertebral endplates consisted of scraping the endplate until punctate bleeding appeared. The major part of the endplate was preserved to withstand interspace distraction and stability. A 97% fusion rate was achieved based on flexion and extension analysis with a six- to 12-month follow-up period. A final average interspace distraction of 2.39 mm was reported. The graft should consist of a rigid structure that exceeds physiologic loads anticipated in the postoperative period, and the composition to promote arthrodesis. Anterior lumbar fusion with femoral allograft is an excellent procedure, but long-term further follow-up studies and statistical data are essential.