Roentgenological assessment of the lumbar anterior interbody fusion with regard to risk factors of the non-union.

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Thirty-nine patients (29 males and 10 females) who underwent anterior interbody fusion for lumbar disc derangement during 1975-1987 were examined radiologically 0.5 to 10 years after operation. The mean age of patients at the time of surgery was 37 years and ranged from 19 to 62 years. The indication for operation were as follows:1) chronic intervertebral disc degeneration, 23 cases; 2) spondylosis, 8 cases; 3) spondylolytic spondylolisthesis, 7 cases; and 4) degenerative spondylolisthesis, 1 case.The following roentgenological measurements were performed: 1) fusion rate, 2) lordosis angle (L1-L5, L4-L5, L5-S1) 3) preoperative ROM of the intervertebral joint, 4) pedicle-facet angle, 5) lumbo-sacral angle, 6) vertebral index, 7) insertion direction and position of the grafted bone, and 8) collapsing rate of the grafted bone.The fusion rate was 60.5% (L4/5: 70.0%, L5/S1: 56.3%). The collapsing rate of grafted bone was 30.5% in non-union group and 21.9% in solid fusion group. The preoperative L5-S1 lordosis angle in non-union group was significantly greater than fusion group. The lumbo-sacral angle in non-union group tended to be greater than other group. We concluded that the roentgenological risk factor of the lumbar interbody fusion was alignment of the lumbo-sacral junction without regard to surgical technique.
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