Abstract
Lumbar fusion is a mainstay in the treatment of low back pain resulting from degenerative disc disease. Anterior lumbar interbody fusion (ALIF) has become a reasonable treatment technique to achieve indirect foraminal decompression with high fusion rates. The aim of the study was to analyse the biometrical parameters of the lumbar spine and the clinical outcome. The medical records of 51 patients treated with ALIF between 2012 and 2016 were retrospectively reviewed. Anterior and posterior disc height (DH), lumbar lordosis (LL), local disc angle (LDA) and foraminal dimensions were obtained on pre- and postoperative plain radiographs and computed tomography scans using ImageJ and Surgimap software according to the pedicle–pedicle technique. To evaluate the interbody fusion status on the last follow-up CT scans, we used Bridwell criteria. Preoperative and 12 months postoperative Oswestry Disability Index (ODI) scores were determined for all patients. The average length of hospitalisation was 4 days. Most of the patients had degenerative disc disease with foraminal stenosis. Five patients had early complications like paresthesia of lower limbs, sympathetic dysfunction or wound infections, but there were no major complications. Statistically significant (P < .01) improvement was observed in foraminal dimensions (area = 49%, height = 33% and width = 19%), anterior DH (49%), posterior DH (69%), LDA (47%) and LL (17.5%). Posterior DH correlated significantly with foramen height improvement. Radiographic evidence of fusion according to the modified Bridwell criteria (grade I and grade II) was observed in 96% (49/51) of the patients in the last CT of the lumbar spine. We also observed significant improvement in functional recovery in 94% of patients. The mini-open ALIF approach is a reasonable alternative to the more extensive posterior approaches. ALIF significantly restores the height of the intervertebral disc, indirectly increases foraminal dimensions, increases lordosis angle with significant short and long-term pain relief and functional recovery.
Highlights
Low back pain (LBP) is one of the most common health problems with 1-month prevalence of 23.2% [11] being the most significant single cause of absence from work [3]
To calculate foraminal height (FH), width (FW) and area of the foramen (FA), we evaluated CT scans in three projections: axial plane, along with the midline of both the pedicles in the coronal plane and the sagittal plane perpendicular to the intervertebral space (Fig. 1)
The implant sizing varied across patients in accordance with the disc height of neighbouring healthy lumbar discs, median implant size was 13.5 mm (12–15 mm) with 12° lordotic angle (48 patients vs 3 patients treated with 8° angle implant) to ensure sufficient distraction
Summary
Low back pain (LBP) is one of the most common health problems with 1-month prevalence of 23.2% [11] being the most significant single cause of absence from work [3]. In cases not responding to the conservative treatment, many surgical options have been established for a variety of lumbar pathologies. Despite being an established procedure for a different spine pathology, there are currently no definitive studies demonstrating that any one technique is more efficacious than others. It gives a possibility to remove more disc material as a pain resource than other approaches, provides greater bone-graft contact area and allows to avoid extensive paraspinal muscle dissection. It can increase a disc space height and a Neurosurg Rev (2020) 43:687–693 foraminal area ensuring indirect nerve root decompression. Lordotic cages can restore an angle of lumbar lordosis and improve sagittal balance [12, 20, 24]
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