Anterior Lumbar lnterbody Fusion Utilizing Titanium Mesh Cages and Coralline Hydroxyapatite

Introduction: Screw–in cages have opened to a rave review but have not yet stood the test of time. Anatomic cages still provide support and include a large interface for bony fusion. Morbidity rates from iliac crest harvesting have been reported to be as high as 25%.

Materials & Methods: Harms cages are anatomic, titanium mesh cages. Coralline Hydroxyapatite is an osteoconductive compound manufactured from sea coral, similar in structure to cancellous bone. This is a retrospective series of 50 patients who underwent successful anterior interbody fusion utilizing (Harms) cages filled with coralline hydroxyapatite granules and Graft0n. All 50 patients also underwent posterior instrumentation with either transiaminar or transpedicular screws and posterolateral fusion. There were 25 single–level, and 25 double–level fusions. All 50 patients filled out questionnaires at their most recent follow–up (at least 36 months postop). Updated radiographs were also taken at that time and evaluated independently.

Results: The average follow–up in this series was 48 months (39–64 months). There were no implant–related complications. Posterior hardware was completely removed in 6 patients; 5 with a solid arthrodesis. Independent radiographic evaluation noted a (96%) fusion rate. Average pain decreased 60%. A total of 70% of all patients either returned to work or to home activities at an average of 8 months postop.

Conclusions: Based on these results we believe the combination of Harms titanium mesh cages and processed sea coral is effective for anterior interbody fusion of the lumbar spine when used in conjunction with rigid posterior fixation and posterolateral fusion.