Anterior and lateral lumbar interbody fusion with supplemental interspinous process fixation: Outcomes from a multicenter, prospective, randomized, controlled study

Ripul R Panchal, Ryan Denhaese, Clint Hill, K. Brandon Strenge, Alexandre De Moura, Peter Passias, Paul Arnold, Andrew Cappuccino, M. David Dennis, Andy Kranenburg, Brieta Ventimiglia, Kim Martin, Chris Ferry, Sarah Martineck, Camille Moore, Kee Kim

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Rigid interspinous process fixation (ISPF) has received consideration as an efficient, minimally disruptive technique in supporting lumbar interbody fusion. However, despite advantageous intraoperative utility, limited evidence exists characterizing midterm to long-term clinical outcomes with ISPF. The objective of this multicenter study was to prospectively assess patients receiving single-level anterior (ALIF) or lateral (LLIF) lumbar interbody fusion with adjunctive ISPF. Methods: This was a prospective, randomized, multicenter (11 investigators), noninferiority trial. All patients received single-level ALIF or LLIF with supplemental ISPF (n = 66) or pedicle screw fixation (PSF; n = 37) for degenerative disc disease and/or spondylolisthesis (grade ≤2). The randomization patient ratio was 2:1, ISPF/PSF. Perioperative and follow-up outcomes were collected (6 weeks, 3 months, 6 months, and 12 months). Results: For ISPF patients, mean posterior intraoperative outcomes were: blood loss, 70.9 mL; operating time, 52.2 minutes; incision length, 5.5 cm; and fluoroscopic imaging time, 10.4 seconds. Statistically significant improvement in patient Oswestry Disability Index scores were achieved by just 6 weeks after operation (P < 01) and improved out to 12 months for the ISPF cohort. Patient-reported 36-Item Short Form Health Survey and Zurich Claudication Questionnaire scores were also significantly improved from baseline to 12 months in the ISPF cohort (P < 01). A total of 92.7% of ISPF patients exhibited interspinous fusion at 12 months. One ISPF patient (1.5%) required a secondary surgical intervention of possible relation to the posterior instrumentation/procedure. Conclusion: ISPF can be achieved quickly, with minimal tissue disruption and complication. In supplementing ALIF and LLIF, ISPF supported significant improvement in early postoperative (≤12 months) patient-reported outcomes, while facilitating robust posterior fusion.

Original languageEnglish (US)
Pages (from-to)172-184
Number of pages13
JournalInternational Journal of Spine Surgery
Issue number2
StatePublished - Jan 1 2018


  • ALIF
  • Anterior lumbar interbody fusion
  • Degenerative disc disease
  • Interspinous process fixation
  • ISPF
  • Lateral lumbar interbody fusion
  • LLIF
  • Lumbar spine
  • Minimally invasive
  • MIS
  • Posterior fixation
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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