The Effect of Alendronate on Subsidence After Lateral Transpsoas Interbody Fusion: A Preliminary Report

Background Success after lateral transpsoas interbody fusion (LLIF) partially depends on avoidance of subsidence to maintain spinal alignment, disc space height, and indirect neural decompression. Techniques for preventing subsidence have focused largely on surgical and biomechanical properties of spinal reconstruction; however, medical management may also affect subsidence rates as well. The purpose of this study is to examine the effect of alendronate on minimally invasive LLIF patients with regard to radiographic and catastrophic subsidence.

Methods We followed 26 patients who had LLIF at the L4-5 level (13 on alendronate, 13 control) and 22 patients at the L3-4 level (10 on alendronate, 12 control). Radiographs were reviewed to obtain measurements of subsidence at the 4 corners of the cage at 3 follow-up time points (2–3, 5–8, and 10–12 months). A Tobit mixed model was used to confirm the results.

Results We found no relationship between alendronate and subsidence for L3-4 fusion. At L4-5 we observed increased subsidence in the control group compared to the alendronate group (difference = 0.07 cm, 95% confidence interval [CI]: −0.01, 0.16, P = .08). There was a decrease in subsidence noted for the alendronate group for each time period (differences: 2–3: −0.06 cm, 95% CI: −.28, .15], P = .27; 5–8: −0.14 cm, 95% CI: -0.36, .08, P = 0.10; 10–12: −0.21 cm, 95% CI: −0.48, .04, P = .05).

Conclusions A clear reduction in subsidence was found with the use of postoperative alendronate in patients undergoing L4-5 LLIF. Alendronate had a significant decrease in subsidence at L4-5 after 10–12 months as compared to the control group. Additionally, no patients treated with alendronate had catastrophic subsidence. These data suggest the need for further study of alendronate in the prevention of subsidence after LLIF.

Level of Evidence 3.