360-Degree Complex Primary Reconstruction Using Porous Tantalum Cages For Adult Degenerative Spinal Deformity

Study Design: Retrospective cohort study. Objective: To assess both implant performance and the amount of correction that can be achieved using multilevel anterior lumbar interbody fusion (ALIF). Methods: Retrospective cohort study (n = 178) performed over a 4-year period. Surgical variables examined included blood loss, operative time, perioperative complications, and secondary/revision procedures. Follow-up radiographic assessment was performed to record implant-related problems. Radiographic parameters were examined pre- and postoperatively. Health-related quality of life (HRQOL) outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Descriptive and comparative statistical analysis, using paired-sample t test and repeated-measures analysis of variance (rANOVA), was performed. Results: Lumbar lordosis increased from 42 degrees +/- 17 degrees preoperatively to 55 degrees +/- 11 degrees postoperatively (P < .001). The visual analog scale back pain mean score improved from 8.3 +/- 1.5 preoperatively to 2.6 +/- 2.4 at 2 years (P < .001). The mean Oswestry Disability Index improved from 69.5 +/- 21.5 preoperatively to 19.9 +/- 15.2 at 2 years (P < .001). The EQ-5D mean score improved from 0.2 +/- 0.2 preoperatively to 0.8 +/- 0.1 at 2 years (P = .02). There were no neurological, vascular, or visceral approach-related injuries reported. No rod breakages and no symptomatic nonunions occurred. There was one revision procedure performed for fracture. Conclusions: The use of porous tantalum cages as part of a 360-degree fusion to treat adult degenerative spinal deformity has been demonstrated to be a safe and effective strategy, leading to good clinical, functional, and radiographic outcomes in the short term.