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Timothy C. Ryken, Robert F. Heary, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

may result in more settling and fragmentation (quality of evidence, Class III; strength of recommendation, D). Carbon fiber cages are recommended for arthrodesis after ACDF with fusion rates > 50% (quality of evidence, Class III; strength of recommendation, D). The use of PMMA is not recommended as a means to preserve interspace height after anterior discectomy. Although short-term results are similar to those obtained with bone grafts, fusion generally does not occur when PMMA is used as a spacer, and the long-term consequences have not been described (quality of

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

21 reported that three-dimensional CT reconstruction may be more sensitive than two-dimensional CT reconstruction for the detection of pseudarthrosis. Siambanes and Mather 20 demonstrated that multiplanar CT imaging detected pseudarthrosis in patients who had undergone posterior lumbar interbody fusion compared with plain radiography that had suggested a solid fusion. Santos and colleagues 18 examined 32 patients who underwent anterior lumbar interbody fusion with carbon fiber cages. Plain static radiographs were interpreted to demonstrate fusion at 86% of the

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

. Osseous fusion was present in 95% of patients in the PLIF  group & in 13% of the ALIF group. Small sample size, differing patient selection criteria, & large  “lost to FU” group limit value of study. Chitnavis, et al., 2001 III 50 PLIF patients w/ carbon fiber cages for DDD. In 40 patients (80%) w/ stand-alone PLIF, 10 w/ PSs. PS augmentation of carbon fiber cage PLIF may/may  Prolo scale. Fusion outcome based on established classification w/ dynamic x-rays. 2/3 of patients  not improve outcome or fusion rate

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

deficit or permanent complication. This PLIF resulted in satisfactory outcome w/in short-term  or long-term FU. * ADL = activities of daily living; ALIF = anterior lumbar interbody fusion; CFC = carbon fiber cage; DH = disc herniation; discect = discectomy; facetect = facetectomy; FU = follow up; JOA = Japanese Orthopaedic Association; laminect = laminectomy; LBP = low-back pain; LOS = length of stay; MDH = midline DH; MRI = magnetic resonance imaging; ODI = Oswestry Disability Index; perc = percutaneous; PLIF = posterior LIF; PLL

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Tanvir F. Choudhri, Praveen V. Mummaneni, Sanjay S. Dhall, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Alok Sharan, Jeffrey C. Wang and Michael G. Kaiser

detected pseudarthrosis in patients who had undergone PLIF, compared with plain radiography, which had suggested a solid fusion. 25 Santos and colleagues examined 32 patients who underwent ALIF with carbon fiber cages. 23 Plain static radiographs were interpreted to demonstrate fusion at 86% of the assessed levels. Flexion-extension lumbar radiography suggested fusion rates ranging from 74% to 96% in this same group of patients, depending on the method used to analyze the radiographs. The addition of thin-section helical CT scanning reduced the radiographic fusion rate

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Jeffrey C. Wang, Andrew T. Dailey, Praveen V. Mummaneni, Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Michael W. Groff, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Sanjay S. Dhall and Michael G. Kaiser

fiber cages were implanted . J Neurosurg 95 : 2 Suppl 190 – 195 , 2001 6 Donceel P , Du Bois M : Fitness for work after surgery for lumbar disc herniation: a retrospective study . Eur Spine J 7 : 29 – 35 , 1998 7 Eie N : Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion . Acta Neurochir (Wien) 41 : 107 – 113 , 1978 8 Fu TS , Lai PL , Tsai TT , Niu CC , Chen LH , Chen WJ : Long-term results of disc excision for recurrent lumbar disc herniation with or without

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Praveen V. Mummaneni, Sanjay S. Dhall, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Tanvir F. Choudhri, Alok Sharan, Jeffrey C. Wang and Michael G. Kaiser

Description Results Conclusion Christensen et al., 2002 II: Prospective randomized clinical trial that was down-graded due to using only static radiographs to evaluate fusion status. A prospective randomized clinical study analyzed the effects of circumferential fusion using ALIF radiolucent carbon fiber cages & titanium posterior instrumentation vs instrumented PLF (w/ pedicle screws) w/ 2-yr follow-up. The circumferential lumbar fusion group had a higher fusion rate w/ significantly fewer reops, showed a tendency toward better functional outcome than the