ANTERIOR LUMBAR INTERBODY FUSION WITH THE HARTSHILL HORSESHOE CAGE- OUTCOME IN PATIENTS WITH TWO YEAR FOLLOW-UP

Abstract

Objectives: To assess the outcome of patients undergoing anterior lumbar interbody fusion with the Hartshill Horseshoe cage device.

Study Design: Prospective cohort of patients from a single centre in the UK

Methods: 20 patients underwent anterior lumbar inter-body fusion from September 1994 to November 2002. All patients underwent primary anterior fusion alone. The diagnosis was back pain alone in 10 patients, instability and back pain post discectomy in 9 patients and pseudoarthrosis in the remaining patient. The main outcome measures were oswestry disability index, low back outcome score, visual analogue scale for back and leg pain, modified somatic perception and modified zung depression score.

Results: Follow-up data was available for 17 patients at two years (85%). There were 11 females and 9 males and there average age at operation was 39 years (range 30–50 years). The mean ODI pre-op was 56 and this improved to 30 post-op (p=0.004). The mean LBOS pre-op was 21 and this improved to 41 post-op (p=0.005). The VAS pre-op was 83mm and improved to 48mm postop (p=0.01). Overall 13 of the patients (76%) improved their ODI by a minimum of 10 points. When comparing the groups according to diagnosis, the patients with back pain alone had a 17 point improvement in ODI whereas the patients with back pain post discectomy had a 29 point improvement in ODI (p=0.33). The main complication of surgery was common iliac vein tear occurring in two patients which was repaired intra-operatively.

Conclusion: Anterior lumbar interbody fusion using the Hartshill horseshoe cage device is a safe and effective method of achieving spine stabilisation in patients with back pain. It seems to be particularly effective for those patients who have instability and back pain post-discectomy.