Stand-alone anterolateral lumbar interbody fusion for degenerative spondylolisthesis

Abstract

Objective To evaluate the clinical outcome of anterolateral lumbar interbody fusion (ALLIF) for the treatment of degenerative lumbar spondylolisthesis(DLS). Methods All of 53 patients with degenerative spondylolisthesis were enrolled in this study during January 2014 to January 2016. All patients underwent stand-alone ALLIF with self-locked cage, including 15 males and 38 females with an average of 57.4±11.2 years old. The surgical level included L3,4(4 cases), L4,5(33 cases) and L5S1(16 cases). The operative time, bleed loss and complications were recorded. Clinical outcome was measured by visual analogue scale (VAS), Oswestry disability index (ODI) and the health questionnaire (SF-36). Radiological measures were slippage, disc height, lumbar lordosis, sagittal diameter and area of dural canal, foraminal height and area, and fusion rate. All the data were statistically analyzed. Results All patients were followed up for at least 24 months. The mean operation time was 64.2±12.5 minutes, and the mean bleed loss was 72.8±14.3 ml. No serious complications such as vascular or nerve injury occurred during peri operation. VAS for low back pain, VAS for leg pain and ODI were significantly decreased from 6.8±1.5, 5.6±2.4 and 58.5%±18.6% preoperatively to 1.6±1.2, 1.2±1.1 and 18.5%±8.8% at 24 months postoperatively. The SF-36 scores were improved significantly from 56.7±12.8 preoperatively to 79.4±14.3 at 24 months postoperatively. Slippage of patients was reduced significantly from 22.5%±8.3% preoperatively to 5.7%±2.3%. Disc height and lumbar lordosis were significantly increased from 6.2±1.6 mm and 46.4°±9.2° preoperatively to 10.5±1.4 mm and 53.2°±11.2° at 24 months postoperatively. Sagittal diameter and cross-sectional area of thecal sac were significantly increased from 11.7±2.2 mm and 78.4±28.6 mm2 preoperatively to 13.8±1.6 mm and 112.5±23.9 mm2 at 6 months postoperatively. Intervertebral foramina height and area were significantly increased from 15.8±4.3 mm and 136.5±25.6 mm2 preoperatively to 19.2±2.5 mm and 157.6±23.1 mm2 at 6 months postoperatively. At 24 months follow-up, the fusion rate was 100% and the subsidence rate was 10.5%. Conclusion Stand-alone ALLIF could achieve satisfactory clinical results and reduction for DLS. Disc height and lumbar lordosis were restored. Efficient decompression was obtained with significantly increased sagittal diameter and cross-sectional area of thecal sac and intervertebral foramina height and area. Stand-alone ALLIF provides a new surgical strategy for the treatment of DLS. Key words: Lumbar vertebrae; Spondylolysis; Surgical procedures, minimally invasive; Spinal fusion