Abstract
This research compared the incidence of adjacent segment pathology (ASP) between anterior interbody lumbar fusion (ALIF) treatment and transforaminal lumbar interbody fusion (TLIF) treatment. Seventy patients were included in this retrospective study: 30 patients received ALIF treatment, and 40 patients received TLIF treatment at a single medical center between 2011 and 2020 with a follow-up of at least 12 months. The outcomes were radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP). The mean follow-up period was 42.10 ± 22.61 months in the ALIF group and 56.20 ± 29.91 months in the TLIF group. Following single-level lumbosacral fusion, ALIF is superior to TLIF in maintaining lumbar lordosis, whereas the risk of adjacent instability in the ALIF group is significantly higher. Regarding ASP, the incidence of overall RASP and CASP did not differ significantly between ALIF and TLIF groups.
Highlights
Adjacent segment pathology (ASP) is a major adverse event of lumbar or lumbosacral fusion
Adjacent segments in this study were defined as two cephalad lumbar motion segments above the L5–S1 spinal fusion [21]
PT, PI-lumbar lordosis (LL), LL, and segment lordosis New (SL) were not significantly different between the of one or more of the following spinal lesions, which did not occur before L5–S1 lumbar fusion at L3–L4 or L4–L5 level: (1) disk degeneration, (2) listhesis, (3) compression fracture, and (4) instability [7,12,17,22]
Summary
Adjacent segment pathology (ASP) is a major adverse event of lumbar or lumbosacral fusion. According to a biomechanical study, the lumbosacral junction is the most critical segment for sagittal alignment [1]. According to a relevant systematic review [5], the incidence of RASP after lumbar fusion ranges from 10.8% to 100% (3–19.5% per year), and that of CASP ranges from 2.6% to 30.3% (0.4–5.1% per year). The risk factors for ASP can be divided into pre-existing factors (age, sex, osteoporosis diagnosis, smoking status, physical activity level, obesity status, menopause diagnosis, bone mineral density, and pre-operation pathology at adjacent segment) and surgery-related factors (postoperative sagittal alignment, adjacent segment operation, the position of pedicle screws, and floating fusion) [6,7,8]
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