Anterior Interbody Lumbar Spine Fusion for Incapacitating Disc Degeneration and Spondylolisthesis

Anterior interbody lumbar spine fusion by the extraperitoneal technique was performed on 98 patients with incapacitating low-back pain due to degeneration of the fourth or fifth lumbar disc (56 patients) or spondylolisthesis (42 patients). Of the discs investigated 135 proved to be degenerated, often severely, and 114 were fused. In 75 per cent of the cases no complications occurred; however, 11 patients developed thrombophlebitis, two fatal pulmonary embolism, four mild pulmonary infarcts, and three pulmonary atelectasis. At follow-up, 3-8 years later, the fusions were solid in 91 per cent and after re-operation in 94 per cent. Among the patients with spondylolisthesis the fusions were not solid in 14 per cent and among those with disc degeneration in 6 per cent. Improvement or cure was reported by 73 per cent of the patients. Thirty-one patients had constant pain. In 21 of them there was a somatic and in a few also a psychological explanation. Sixty-eight per cent were working. Sixty per cent of those patients who underwent the operation after the age of 45 were receiving a disablement pension. An attitude of reserve should be taken in operating on patients with a history of one or more operations for disc herniation, as there may be nerve root adhesions. Patients with spondylolisthesis should be followed up for at least 3 years, and if there is a suspicion of incipient pseudarthrosis they should be treated by fusion with screws through the arch defects or by classical posterior spondylodesis. The decision regarding indications for the operation and the operation itself should still be in the hands of very experienced orthopaedic surgeons, and it must be emphasized that the postoperative management, especially the prophylaxis against thrombosis, makes great demands on the staff.