Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3° and lumbar lordosis by 6.2°, whereas TLIF decreased the local disc angle by 0.1° and lumbar lordosis by 2.1°.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.</jats:p></jats:sec>

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

“…It is interesting, however, that with interbody reconstruction, the degree of lordosis recreation can be limited and may not recreate normality [1][2][3][16][17][18]]-a concern when we recognise the significant lordosis in the normal L4/5 and L5/S1 discs [1,5,7,12].…”

Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion as an Adjunct to Posterior Instrumented Correction of Degenerative Lumbar Scoliosis

“…14 Structural anterior column support provides several benefits, including improved stability, decreased stress on screws, improved fusion rates, and better lumbar lordosis. [15][16][17][18][19][20][21] Deformity correction has not consistently improved with the addition of anterior surgery in the degenerative lumbar scoliosis. 18,[21][22][23] Anterior lumbar interbody fusion (ALIF) has been a reliable technique for treating adult spinal deformity.…”

A morphometric analysis of contralateral neural foramen in TLIF

“…Failure to restore these parameters can result in permanent loss of neural passage and sagittal balance, potentially leading to poor outcomes. Both TLIF and PLIF have been developed to increase the intervertebral disc space, FH, and lumbar lordosis for neural decompression and restoration of sagittal alignment [5,14]. Interestingly, there was a case report of contralateral radiculopathy following TLIF [7].…”

“…A likely explanation for this is that an intact facet joint may limit rod compression, consequently limiting the restoration of SCA in the TLIF group. While increased SCA can restore sagittal balance, it may decrease foraminal height [14]. It is assumed that this result was caused by the wedge effect of an inserted cage.…”