Anterior lumbar interbody fusion reduces thecal sac compression in the setting of degenerative spondylolisthesis

Abstract

Surgical management for central and lateral recess thecal sac compression in the setting of degenerative spondylolisthesis (DS) has traditionally involved a posterior approach to decompression with associated fusion [ [1] Weinstein JN Tosteson TD Lurie JD Tosteson A Blood E Herkowitz H et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial. Spine. 2010; 35: 1329-1338 Crossref PubMed Scopus (383) Google Scholar , [2] Mobbs RJ Loganathan A Yeung V Rao PJ Indications for anterior lumbar interbody fusion. Orthop Surg. 2013; 5: 153-163 Crossref PubMed Scopus (83) Google Scholar ]. However, the posterior approach to lumbar interbody fusion involves significant disruption of the posterior elements, entrance into the spinal canal, and nerve root retraction, which contribute to epidural scarring and perineural fibrosis that may be associated with delayed recovery and chronic radiculopathy [ [3] Fan SW Hu ZJ Fang XQ Zhao FD Huang Y Yu HJ Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Orthop Surg. 2010; 2: 194-200 Crossref PubMed Scopus (60) Google Scholar , [4] Zhang Q Yuan Z Zhou M Liu H Xu Y Ren Y A comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion: a literature review and meta-analysis. BMC Musculoskelet Disord. 2014; 15: 367 Crossref PubMed Scopus (51) Google Scholar ]. An anterior approach to decompression and fusion avoids these sequelae of posterior surgery while also conferring advantages over transforaminal lumbar interbody fusion, permitting more extensive discectomy, larger surface area for placement of an interbody fusion device, and greater correction of lordosis and restoration of foraminal height [ 5 Hsieh PC Koski TR O'Shaughnessy BA Sugrue P Salehi S Ondra S et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine. 2007; 7: 379-386 Crossref PubMed Scopus (256) Google Scholar , 6 Phan K Thayaparan GK Mobbs RJ Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion—systematic review and meta-analysis. Br J Neurosurg. 2015; 29: 705-711 Crossref PubMed Scopus (108) Google Scholar , 7 Rao PJ Maharaj MM Phan K Lakshan Abeygunasekara M Mobbs RJ Indirect foraminal decompression after anterior lumbar interbody fusion: a prospective radiographic study using a new pedicle-to-pedicle technique. Spine J. 2015; 15: 817-824 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar ]. In theory, an anterior approach may also provide indirect decompression of the spinal canal via ligamentotaxis and straightening of the posterior elements.