• John S Thalgott, James M Giuffre, Zendek Klezl, and Marcus Timlin.
• International Spinal Development and Research Foundation, 600 South Rancho Drive, Suite 101, Las Vegas, NV 89106, USA. spine@spine-research.org
• Spine J. 2002 Jan 1; 2 (1): 63-9.

Background ContextAnterior lumbar interbody fusion (ALIF) has become one of the primary choices for eliminating motion between vertebral segments in patients with severe discogenic pain and other lumbar pathologies. Autograft is the gold standard for spinal fusion. However, multiple authors have reported complication and morbidity rates associated with iliac crest harvesting to be as high as 25%. Drawbacks to the use of allograft in the anterior column include slower incorporation rates, the possibility for disease transmission, increasing cost resulting from stringent processing and unavailability on a worldwide basis resulting from religious and economic concerns.PurposeTo determine the clinical and arthrodesis efficacy of coralline hydroxyapatite as an osteoconductive bone graft substitute in the anterior lumbar spine using a titanium mesh cage.Study DesignA series of 50 patients returning for long-term prospective follow-up, implanted with titanium mesh cages filled with coralline hydroxyapatite and demineralized bone matrix for ALIF as part of a circumferential fusion.Patient SampleLong-term clinical and radiographic follow-up were examined for the first 50 patients undergoing this technique by one surgeon.Outcome MeasuresPain was measured with a visual analog scale and function was measured with the Oswestry Disability Index.MethodsAll 50 patients underwent successful ALIF with titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix, as well as an autologous posterolateral fusion with rigid posterior instrumentation. Patients filled out follow-up questionnaires and appropriate radiographs were taken.ResultsA solid fusion rate of 96% was achieved. Mean pain decrease was 60% overall. A total of 70% of all patients either returned to work or to full home activities at a mean of 8 months after surgery. Ninety percent felt the surgery was successful.ConclusionsThe combination of titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix is effective for anterior interbody fusion of the lumbar spine when used as part of a rigidly instrumented circumferential fusion.

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