Stand-alone anterior lumbar interbody fusion – complications and perioperative results

Abstract

ObjectivesHistorically, anterior lumbar interbody fusion (ALIF) was related to high rates of intraoperative complications and adverse events related to interbody devices. In recent decades, there have been technical adjustments, and cages that are more suitable have emerged. The aim of this study is to evaluate the efficacy and complication rate of the use of stand-alone mini-ALIF using a self-locking cage.MethodsRetrospective single center study. Inclusion criteria: retroperitoneal mini-ALIF for single-level fusion (L5S1); self-locking cage; DDD/stenosis and grade I spondylolisthesis. Exclusion criteria: posterior supplementation, previous fusion/arthroplasty. Endpoints: surgery data, intraoperative and perioperative adverse events related both to surgical access and to the intersomatic device.ResultsEighty-seven cases were enrolled. Median surgical time was 90 min; median blood loss was 100 mL. The median length of stay in the ICU was zero days; median hospital stay was one day. Ten cases had an adverse event (11.5%): four major adverse events (4.6%; 3 L bleeding; DVT; retroperitoneal haematoma; incisional hernia), and seven minor events (8%; peritoneum injury; minor vascular injury; events related to the cage). No cases of retrograde ejaculation were observed. There was improvement in pain, physical restriction, and quality of life (p < 0.001).ConclusionsThe mini-ALIF procedure performed for single-level fusion at the distal lumbar level demonstrated low adverse event rates related to both the surgical approach and to the intersomatic device, with reduced hospital stay and satisfactory perioperative clinical results.

Surgical Therapeutic Strategy of Transdural Nerve Root Herniation during Anterior Lumbar Interbody Fusion: Report of Two Cases

“…However, this is the first case report to our knowledge of incidental durotomy associated with ALIF. So far, there is no published report describing ventral durotomy during ALIF 11,12) . Anterior discectomy and decompression was performed by one surgical team.…”

Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature

“…When lumbar interbody fusion is indicated in a patient, the decision must be made on which approach to utilize safely and effectively. The anterior approach to the lumbar spine for interbody fusion is one of the predominant techniques for the surgical treatment of discogenic lumbar pain [11]. Historically, ALIF has been linked with high intraoperative complications and failure of fusion due to inadequate cages [11].…”

“…The anterior approach to the lumbar spine for interbody fusion is one of the predominant techniques for the surgical treatment of discogenic lumbar pain [11]. Historically, ALIF has been linked with high intraoperative complications and failure of fusion due to inadequate cages [11]. With the advent of new operative techniques and cages, stand-alone ALIF surgery has been shown to have satisfactory rates of complication and fusion.…”

“…Amaral et al performed a retrospective single-center study looking at patients with lumbar stenosis and grade 1 spondylolisthesis who underwent L5-S1 stand-alone ALIF. VAS for back pain decreased from 7.4 preoperatively to 4.2 at three months, and VAS for lower limbs decreased from 5.1 preoperatively to 2.8 at three months, with both differences reaching statistical significance [11]. ODI decreased from 44 preoperatively to 31 at three months, which was also statistically significant [11].…”

“…VAS for back pain decreased from 7.4 preoperatively to 4.2 at three months, and VAS for lower limbs decreased from 5.1 preoperatively to 2.8 at three months, with both differences reaching statistical significance [11]. ODI decreased from 44 preoperatively to 31 at three months, which was also statistically significant [11]. Out of 87 patients, two had venous damage intraoperatively, and two had an accidental opening of the peritoneum.…”