ALIF versus TLIF for Post-Discectomy Syndrome

Jägersberg, Max; Schneider, Kristian Nikolaus; Schaller, Carlo; Richter, Marcus

doi:10.1055/s-0034-1372432

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…Nevertheless, because the significance in MCID achievement differences were merely present in the weeks after surgery but not at 6 months and onward and mean PROMs did not differ at any time point, our results suggest that ALIF and TLIF isthmic spondylolisthesis patients will generally experience comparable outcomes in the months to years after fusion. The long-term MCID data provided from our analysis are consistent with the long-term clinical outcomes of Jacob et al 9 These results are also similar to those of Jägersberg et al, 29 in which both ALIF and TLIF cohorts markedly improved in pain scores, with no notable differences in pain between groups.…”

Section: Discussionsupporting

confidence: 90%

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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Introduction:Limited studies have compared minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with anterior lumbar interbody fusion (ALIF) for the treatment of isthmic spondylolisthesis. This study aims to compare perioperative variables, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates between these surgical approaches.Methods:Patients with isthmic spondylolisthesis undergoing primary, single-level MIS TLIF or ALIF were identified in a surgical database. Patients were divided into MIS TLIF and ALIF cohorts. Demographics and perioperative characteristics were collected and compared between groups using the chi square test or Student t-test. PROMs including the Patient-Reported Outcomes Measurement Information System Physical Function, 12-Item Short Form Physical Composite Score, visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index were collected at preoperative, 6-, 12-week, 6-month, 1-, and 2-year time points. Mean PROMs were compared using the Student t-test for independent samples. MCID attainment was determined using established values in the literature; achievement rates by grouping were compared using chi square analysis.Results:One hundred seventy-one patients were included, 121 MIS TLIF and 50 ALIF. No demographic differences were observed. Mean surgical times were 139.7 minutes (MIS TLIF) and 165.5 minutes (ALIF) (P < 0.001). No other perioperative differences were observed. Mean estimated blood loss values were 63.8 mL (MIS TLIF) and 73.7 mL (ALIF). Mean postoperative lengths of stay were 43.9 hours (MIS TLIF) and 42.5 hours (ALIF). Mean PROMs did not markedly differ among groups at any time point. MCID attainment was markedly higher among MIS TLIF patients for the Oswestry Disability Index at 6 weeks (P = 0.046) and 12 weeks (P = 0.007), Patient-Reported Outcomes Measurement Information System Physical Function at 12 weeks (P = 0.015), and VAS leg at 6 weeks (P = 0.031) and 12 weeks (P = 0.045). No other notable differences were observed among MCID achievement by grouping.Discussion:While single-level ALIF demonstrated markedly higher surgical times, other perioperative characteristics and PROMs were comparable among ALIF and MIS TLIF patients. Although MCID achievement rates were generally lower for disability and leg pain among ALIF patients, significance was not reached at 6 months, 1 year, or during the overall postoperative period after fusion.

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Section: Discussionsupporting

confidence: 90%

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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“…3 The biomechanical properties and outcomes of various types of fusion were studied in several articles and it has been reported that interbody fusion from the anterior approach does not provide considerable benefits over transforaminal interbody fusion, nonetheless, the stability provided by ALIF cage was slightly higher. 14-16 According to the results of the regression analysis, application of a broad cage used for ALIF was associated with a significant decrease in the rate of screws loosening. A possible explanation of the observed effect is that cages applied for TLIF procedure provides support in the central part of the endplate, conversely broad cage provides load on periphery of endplate with greater compressive strength and distribution of load on greater surface, finally providing tolerance to the applied forces.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…12,13 It has been reported that the lack of the anterior support is a significant factor for pedicle screws loosening; however, the extent of the influence and the role of the applied fusion type remain undetermined. [14][15][16] Despite a considerable number of studies that were published on screws loosening, the reported data remains inconclusive because of different criteria used as indicator for implant loosening; the enrolled groups were heterogeneous regarding pathology without assessment of potential bias related. Furthermore, the majority of studies investigated the only single factor influence without assessment of other potential effects.…”

Section: Introductionmentioning

confidence: 99%

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Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution

Bokov

Bulkin

Aleynik

et al. 2018

Global Spine Journal

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Study Design:Retrospective cohort study.Objective:To determine risk factors that may affect the rate of pedicle screws loosening in patients with degenerative diseases of the lumbar spine.Methods:A total of 250 patients with a low-grade spondylolisthesis and lumbar instability associated with degenerative diseases were enrolled. Preoperatively patients underwent computed tomography (CT) and cancellous bone radiodensity of a vertebral body was measured in Hounsfield units (HU). Pedicle screw fixation was used to treat patients either with a posterior fusion only or in combination with transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and direct lateral interbody fusion (D-LIF). Minimal follow-up period accounted for 18 months. Cases with screw loosening were registered assessing association with risk factors using logistic regression.Results:The rate of screw loosening was in positive correlation with the number fused levels and decreasing bone radiodensity. Fusion with a greater load-bearing surface cage was associated with the decrease in rate of pedicle screws loosening. Incomplete reduction in case of spondylolisthesis, bilateral facet joints removal, and laminectomy performed without anterior support favored pedicle screws loosening development. The estimated model classifies correctly 79% of cases with the specificity and sensitivity accounting for 87% and 66% respectively.Conclusions:The decreasing bone radiodensity in Hounsfield units has a considerable correlation with the rate of pedicle screws loosening. On the other hand, the length of fixation and applied surgical technique including fusion type also have a significant impact on complication rate. Spinal instrumentations should be planned by taking into account all potential risk factors and not characteristics relevant to bone quality assessment alone.

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“…Because the posterior spinal structure and pedicles were preserved, this surgical technique may not hamper further surgery. Use of DLIF and lateral screws for ASD may be considered when multiple degeneration is present in the other spinal levels, and further ASD and re-revision surgeries could be expected, due to a lack of trauma to the posterior spinal structures 15) . A long-term follow-up study with a larger number of patients is required.…”

Section: Discussionmentioning

confidence: 99%

Lateral Lumbar Interbody Fusion and <i>in Situ</i> Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

Choi

Kwon

Moon

et al. 2017

J Korean Neurosurg Soc

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ObjectiveThe purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease.MethodsThe medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.ResultsThe median follow-up period was 13 months (range, 3–48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients.ConclusionThis study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

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ALIF versus TLIF for Post-Discectomy Syndrome

Cited by 9 publications

References 30 publications

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution

Lateral Lumbar Interbody Fusion and <i>in Situ</i> Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

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