A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral lumbar fusion (PLF)

Abstract

Purpose The rate of elective lumbar fusion has continued to increase over the past two decades. However, there remains to be a consensus on the optimal fusion technique. This study aims to compare stand-alone anterior lumbar interbody fusion (ALIF) with posterior fusion techniques in patients with spondylolisthesis and degenerative disc disease through a systematic review and meta-analysis of the available literature. Methods A systematic review was performed by searching the Cochrane Register of Trials, MEDLINE, and EMBASE from inception to 2022. In the two-stage screening process, three reviewers independently reviewed titles and abstracts. The full-text reports of the remaining studies were then inspected for eligibility. Conflicts were resolved through consensus discussion. Two reviewers then extracted study data, assessed it for quality, and analysed it. Results After the initial search and removal of duplicate records, 16,435 studies were screened. Twenty-one eligible studies (3686 patients) were ultimately included, which compared stand-alone ALIF with posterior approaches such as posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and posterolateral lumbar fusion (PLF). A meta-analysis showed surgical time and blood loss was significantly lower in ALIF than in TLIF/PLIF, but not in those who underwent PLF (p = 0.08). The length of hospital stay was significantly shorter in ALIF than in TLIF, but not in PLIF or PLF. Fusion rates were similar between the ALIF and posterior approaches. The Visual Analogue Scale (VAS) scores for back and leg pain were not significantly different between the ALIF and PLIF/TLIF groups. However, VAS back pain favoured ALIF over PLF at one year (n = 21, MD − 1.00, CI − 1.47, − 0.53), and at two years (2 studies, n = 67, MD − 1.39, CI − 1.67, − 1.11). The VAS leg pain scores (n = 46, MD 0.50, CI 0.12 to 0.88) at two years significantly favoured PLF. The Oswestry Disability Index (ODI) scores at one year were not significantly different between ALIF and the posterior approaches. At two years, ODI scores were also similar between the ALIF and the TLIF/PLIF. However, the ODI scores at two years (2 studies, n = 67, MD − 7.59, CI − 13.33, − 1.85) significantly favoured ALIF over PLF (I2 = 70%). The Japanese Orthopaedic Association Score (JOAS) for low back pain at one year (n = 21, MD − 0.50, CI − 0.78) and two years (two studies, n = 67, MD − 0.36, CI − 0.65, − 0.07) significantly favoured ALIF over PLF. No significant differences were found in leg pain at the 2-year follow-up. Adverse events displayed no significant differences between the ALIF and posterior approaches. Conclusions Stand-alone-ALIF demonstrated a shorter operative time and less blood loss than the PLIF/TLIF approach. Hospitalisation time is reduced with ALIF compared with TLIF. Patient-reported outcome measures were equivocal with PLIF or TLIF. VAS and JOAS, back pain, and ODI scores mainly favoured ALIF over PLF. Adverse events were equivocal between the ALIF and posterior fusion approaches.

Clinical observation of fully visualized spinal endoscopic lumbar interbody fusion for the treatment of single-segment II lumbar spondylolisthesis

“…Open lumbar fusion is the traditional procedure for the treatment of lumbar spondylolisthesis, but this procedure requires extensive stripping of soft tissues such as the lumbar muscles and prolonged distraction, which leads to nerve damage and insu cient blood supply to the paravertebral muscles, thus increasing the incidence of chronic pain [10][11]. The paravertebral muscles are critical for supporting spinal extension, maintaining lumbar lordosis and achieving dynamic spinal stability, so the risk of medically induced injury to the paravertebral muscles should be minimized during surgery [12][13]. The development of spinal endoscopic techniques has brought new opportunities for the treatment of lumbar spondylolisthesis, offering new possibilities for patients to achieve faster and more effective rehabilitation by providing more precise observation and manipulation in a minimally invasive manner [14].…”

Fusion’s Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF)

“…Hoy et al, in a randomized clinical trial, through comparing PLF and TLIF in terms of post-operative functional outcomes, showed comparable improvement rates, with no statistical difference in daily function, work, leisure, or anxiety [21]. In another recent extended systematic review, summarizing data from 21 studies with 3686 patients, TLIF and PLF procedures showed similar improvement in terms of patient-reported outcomes [22]. Nevertheless, in reviewing the literature regarding fusion rates following both procedures, a slightly significant difference favoring TLIF surgery is presented [6,19,23].…”

Evaluation of the Fusion Rate and Safety of Escherichia coli-Derived rhBMP-2 in Transforaminal Lumbar Interbody Fusion for Patients with Degenerative Lumbar Disease: A Prospective, Multicenter, Single-Arm Trial

“…Transforaminal lumbar interbody fusion (TLIF) has become a commonly used surgical technique for these conditions, providing relief by relieving pressure and stabilizing the afflicted parts of the spine. The achievement of a stable spinal fusion is crucial for the success of TLIF [ 3 , 4 , 5 ], and this outcome is impacted by several factors such as patient characteristics, surgical technique, and the choice of fusion materials. Traditionally, autografts have been considered the most reliable method for spinal fusion because of their ability to promote bone formation, stimulate bone growth, and provide a scaffold for new bone tissue [ 6 , 7 ].…”