Anterior Discectomy and Fusion With BAK: The First 225 Patients

Kenneth L Light, MD

For simple disc herniations unresponsive to conservative treatment, laminotomy and discectomy remains the procedure of choice. There are cases, however, that fail to respond to laminotomy and discectomy. In such cases, stabilization of the spine is often necessary. Anterior discectomy and fusion with the BAK titanium cage has become popular.

The operation offers certain benefits over posterolateral fusion with pedicle screws: 1) The dissection follows anatomic planes making extensive stripping of the spine unnecessary. 2) It provides immediate distration of the disc space and enlargement of the neuro foramen. 3) It maintains normal lumbar lordosis. 4) Postoperative pain is less than with posterolateral fusion.

Since October, 1996, 225 patients have undergone anterior discectomy and fusion using the BAK implant. All patients suffered back pain an average of five years. Most patients had disc protrusions, ten patients had isthmic spondylolisthesis. All patients have been followed up to three years. 90% of patients had immediate relief of leg pain and have not had a recurrence. Most patient's back pain improved immediately after surgery.

After three months 35% of patients were off all narcotic medication. After one month most patients could forward flex touching their hands to their ankles. 35% of workers' compensations cases returned to work within three months. There have been two pseudarthroses to date, no cage dislodging nor revisions.

Anterior discectomy and fusion with the BAK technique is a procedure which carries little morbidity when performed correctly. Ultimately whether it proves to be a viable and successful technique only time will tell.