Abstract
Objective: The use of stand-alone 2-level anterior lumbar interbody fusion (ALIF) for degenerative lumbar disease has been increasing as an alternative to routinely augmenting these constructs with posterior fixation or fusion. Despite the potential benefits of a stand-alone approach (decreased cost and operative time, decreased pain and early mobilization), there is a paucity of information regarding these operations in the literature. This investigation aimed to determine the safety profile, radiographic outcomes including fusion rates, improvement in preoperative pain, and spinopelvic parameter modification, for patients undergoing stand-alone 2-level ALIF.Methods: This retrospective case series involved a chart review of all patients undergoing 2-level stand-alone ALIF at a single tertiary hospital from 2008 to 2018. Data included patient demographics, hospitalization, complications and radiological studies. Visual analog scale (VAS) back and leg scores were measured via patient-administered surveys preoperatively and up to 18 weeks postoperatively.Results: Forty-one patients who underwent L4-S1 stand-alone ALIF were included. Sixteen (39%) of patients had undergone previous posterior lumbar surgery. Length of stay averaged 4.2 days. Complication rates were comparable to 1-level ALIF. Two patients required reoperation. Fusion rates were 100% for L4-5 and 94.4% for L5-S1. There was no significant change in lumbar lordosis (LL) or LL-pelvic incidence (PI), but there was improved segmental lordosis (SL) and disc height at L4-S1 on final follow-up imaging. There was also modest but statistically significant improvement in VAS back and leg scores.Conclusions: Stand-alone 2-level ALIF is an option for a surgeon to perform in the absence of significant instability, even in the setting of prior posterior surgery. These procedures increase SL and disc height, but do not have the same effect on LL or LL-PI.
Highlights
Lumbar interbody fusion can be performed from anterior, lateral, or posterior approaches [1]
Stand-alone 2-level anterior lumbar interbody fusion (ALIF) is an option for a surgeon to perform in the absence of significant instability, even in the setting of prior posterior surgery
When asked about radicular or lower back pain as a percentage of total symptomology, patients noted that an average of 62.4% of their total symptoms were due to back pain
Summary
Lumbar interbody fusion can be performed from anterior (anterior lumbar interbody fusion [ALIF]), lateral (lateral or oblique lumbar interbody fusion [LLIF or OLIF]), or posterior (posterior or transforaminal lumbar interbody fusion [PLIF or TLIF]) approaches [1]. Comparable to posterior and lateral approaches, ALIF is associated with high fusion rates [1,4,5,6]. This approach allows substantial deformity correction and indirect neuroforaminal decompression, while enabling early postoperative mobilization by sparing posterior spinal and psoas muscle dissection [7,8,9,10,11]. Complications can include visceral, ureteral, and vascular injuries, along with retrograde ejaculation secondary to sympathetic injury [13,14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
