Tag: Anterior lumbar interbody fusion

Posted on

Postoperative loss in segmental lumbar lordosis following L5–S1 anterior lumbar interbody fusion

J Neurosurg Spine 44:420–425, 2026

This clinical study evaluates predictors and thresholds for postoperative loss of L5–S1 segmental lordosis following anterior lumbar interbody fusion (ALIF) in 94 adults treated for degenerative disc disease. Multivariate analyses identified baseline obesity, absence of posterior fixation, and larger immediate lordotic correction as independent predictors of 6-week to 1-year segmental lordosis loss, which related to higher rates of cage subsidence and revision.

The authors derived 6-week postoperative L5–S1 lordosis thresholds (overall range 21.6°–26.8°, PI-specific: low 19.0°–24.8°, average 21.0°–26.4°, high 24.1°–28.7°) that minimized subsequent loss and need for revision. Findings support targeted preoperative planning to achieve sustainable correction while balancing risks of overcorrection and subsidence.

Segmental Lordosis Restoration: L5–S1 anterior lumbar interbody fusion (ALIF) provides strong and durable correction of segmental lumbar lordosis and disc height, with most correction maintained at 1 year postoperatively.

Predictors of Lordosis Loss: Baseline obesity, lack of posterior fixation, and larger initial correction in L5–S1 lordosis are independent predictors of postoperative segmental lordosis loss within 1 year.

Complications: Loss of segmental lordosis increases the risk of cage subsidence and revision surgery, particularly due to pseudarthrosis.

Optimal Correction Thresholds: Achieving 6-week postoperative L5–S1 segmental lordosis between 21.6° and 26.8° minimizes the risk of lordotic loss and need for revision; PI-specific thresholds are 19.0°–24.8° (low PI), 21.0°–26.4° (average PI), and 24.1°–28.7° (high PI).

Risks of Overcorrection/Undercorrection: Overcorrection (>26.8°) increases risk of cage subsidence and mechanical complications, while undercorrection (<21.6°) may predispose to implant failure and adjacent segment disease.

Surgical Planning Importance: Preoperative planning should target lordosis correction within these thresholds and consider modifiable risk factors to optimize outcomes and reduce complications.

Comparison to Other Techniques: ALIF offers greater segmental correction than other lumbar interbody fusion techniques such as TLIF or XLIF.

Clinical Implications: Nearly half of patients experience some degree of lordosis loss post-ALIF, highlighting the need for careful patient selection, surgical technique, and postoperative monitoring.

Posted on

Erector spinae plane block during standalone anterior lumbar surgery: impact on early ambulation, length of stay, and inpatient opioid use

J Neurosurg Spine 44:90–98, 2026

This clinical retrospective study assesses the impact of erector spinae plane block (ESPB) as an adjunct to multimodal analgesia in standalone anterior lumbar procedures (ALIF and lumbar TDR). Outcomes compared between ESPB and non-ESPB cohorts include in-hospital pain scores, opioid consumption (MME), time to ambulation, length of stay (LOS), and opioid-related complications.

Results show ESPB associated with lower day-of-surgery pain scores, earlier ambulation, and shorter LOS, with reduced in-hospital oral MME in univariate analysis; preoperative opioid use predicted higher perioperative opioid consumption and urinary retention despite ESPB. The authors emphasize ESPB as a component of enhanced recovery protocols and note limitations of retrospective design and sample size.

Erector Spinae Plane Block (ESPB): ESPB is a regional analgesic technique used as an adjunct in anterior-only lumbar surgeries, such as ALIF and total disc replacement, aiming to improve perioperative pain control and recovery outcomes.

Reduced Pain and Opioid Use: ESPB significantly lowers pain scores on the day of surgery and reduces in-hospital opioid use, especially oral morphine milligram equivalents (MMEs), compared to patients not receiving ESPB.

Shorter Hospital Stay: Patients receiving ESPB experience a significantly shorter hospital length of stay (LOS) and are more likely to be discharged earlier, including same-day discharge, than those without ESPB.

Faster Ambulation: ESPB is associated with a significantly shorter time to first ambulation after surgery, facilitating earlier rehabilitation.

Predictors of Opioid Use: Baseline (preoperative) opioid use is the strongest predictor of higher perioperative opioid requirements and is also linked to a higher incidence of postoperative urinary retention, regardless of ESPB administration.

Subgroup Benefits: Among ESPB patients, those with a shorter LOS (<2 days) had earlier ambulation, lower opioid use, and lower pain scores on postoperative day 1, indicating enhanced early recovery.

Multimodal Pain Management: ESPB should be considered as one component within a comprehensive multimodal pain management strategy (such as ERAS protocols), rather than as a standalone intervention.

Study Limitations: The findings are limited by the retrospective design, potential selection bias, lack of randomization, and incomplete data on preoperative opioid use, highlighting the need for larger, prospective studies

Posted on

Does segmental alignment matter? A novel understanding of segmental compensation and reciprocal change following single-level lumbar reconstruction

J Neurosurg Spine 44:72–79, 2026

This clinical study analyzes segmental compensation and reciprocal changes after single-level L5–S1 anterior lumbar interbody fusion in 100 adults with normal preoperative lumbar lordosis. Using intradiscal angle, motion segment angle, and disc heights, the authors show significant index-level lordosis restoration and correlated increases in overall lumbar lordosis at 1 month and 1 year.

The paper documents consistent reciprocal decreases in lordosis at adjacent L4–5 and L3–4 levels, provides predictive linear equations for adjacent-level change based on index-level IDA change, and argues that restoring segmental lordosis may prevent maladaptive compensation and reduce adjacent segment disease risk, while noting limitations and need for longer follow-up.

Segmental Compensation: Adjacent lumbar spine segments compensate for loss of lordosis at a pathologic segment by increasing their own segmental lordosis to maintain overall lumbar lordosis (LL) within the normal range.

Reciprocal Change After Fusion: Restoration of lordosis at the L5–S1 level via anterior lumbar interbody fusion (ALIF) leads to a significant, measurable decrease in segmental lordosis at adjacent levels (L4–5 and L3–4), demonstrating a reciprocal relationship.

Predictive Model: The degree of reciprocal loss of lordosis at adjacent levels can be predicted using linear equations based on the lordosis gain at the fused segment (e.g., 1-year adjacent level decrease in IDA = −0.195 × [index level 1-year IDA change] + 0.332).

Global Alignment Maintenance: Despite significant increases in lordosis at the surgical level, total lumbar lordosis does not increase by the same amount due to compensatory decreases at adjacent levels, maintaining global alignment.

Clinical Implication: Proper restoration of segmental lordosis at the surgical level may help prevent negative consequences of persistent compensation at adjacent segments, potentially reducing the risk of adjacent segment disease.

Study Population: Findings are based on 100 adults with normal preoperative LL (PI–LL < 10°) who underwent single-level L5–S1 ALIF and achieved ≥5° increase in segmental lordosis postoperatively.

Correlation With Outcomes: Changes in lordosis at the surgical segment positively correlate with changes in overall lumbar lordosis at both 1 month and 1 year postoperatively.

Long-Term Impact: The persistence of reciprocal changes at adjacent segments up to 1 year suggests that segmental compensatory mechanisms are durable and may influence long-term spinal health and surgical planning.

Posted on

Sarcopenia Predicts Early Adjacent Segment Disease Development After Anterior and Oblique Lumbar Interbody Fusion

Operative Neurosurgery 29:667–677, 2025

his clinical study evaluates whether sarcopenia, measured by psoas-to-vertebral body morphometrics on preoperative MRI, predicts early adjacent segment disease (ASD) within three years after anterior or oblique lumbar interbody fusion (ALIF/OLIF). Retrospective analysis of 104 patients found sarcopenia strongly associated with ASD, with sarcopenic patients showing markedly higher ASD rates and greater muscle fat infiltration.

The paper reports that psoas area, P:VBR ratios, and age remained significant predictors on multivariate analysis, while spinopelvic parameters lost significance after adjustment. The authors propose routine preoperative morphometric screening to guide surgical planning, risk counseling, and targeted perioperative optimization for high-risk patients.

• Sarcopenia: Preoperative sarcopenia, defined by reduced psoas muscle area relative to vertebral body area, is a strong independent predictor of early adjacent segment disease (ASD) within 3 years after anterior or oblique lumbar interbody fusion (ALIF/OLIF) ().

• ASD Incidence: 24% of patients developed ASD within 3 years post-ALIF/OLIF; 84.21% of sarcopenic patients developed ASD compared to 10.59% of nonsarcopenic patients.

• Morphometric Assessment: Psoas:vertebral body ratio (P:VBR) at L4 on preoperative MRI provides a simple, objective screening tool for sarcopenia and ASD risk stratification.

• Spinopelvic Parameters: Postoperative pelvic tilt (PT) and pelvic incidence-lumbar lordosis (PI-LL) mismatch were associated with ASD in univariate analysis, but not after multivariate adjustment; sarcopenia remained the strongest predictor.

• Other Risk Factors: Older age, higher preoperative disability (ODI), more instrumented/interbody levels, and prior lumbar surgery also increased ASD risk, while gender, BMI, and comorbidities did not.

• Instrumentation vs. Stand-alone Cages: Patients with stand-alone ALIF/OLIF (no posterior instrumentation) had lower rates of ASD, possibly due to less mechanical stress on adjacent segments.

• Clinical Implications: Identifying sarcopenia preoperatively can inform surgical planning, patient counseling, and may guide targeted pre- and postoperative interventions to improve outcome.

• Future Directions: Further research is needed to determine if interventions like resistance training or dietary modification can reduce ASD risk in sarcopenic patients, and to establish standardized diagnostic criteria for sarcopenia in spine surgery.

Posted on

Robotic‑assisted single‑position lateral for multilevel circumferential lumbar interbody fusion

Acta Neurochirurgica (2023) 165:3963–3967

Lateral lumbar interbody fusion supplemented with insertion of pedicle screws is a surgical procedure that has gained popularity in the last years, becoming an important tool in the armamentarium of spine surgeons. In recent years, there is a trend to complete both procedures in a single position, thus avoiding flipping the patient prone to insert the pedicle screws. Methods

We describe a step-by-step workflow of the robotic-assisted technique for multilevel lateral lumbar interbody fusion supplemented with posterior instrumentation. The surgical procedure is performed in a single lateral position. For access to L4–5 or L5–S1, an oblique abdominal incision is performed in the same position, and the desired disc space is approached through an oblique or anterior corridor in the retroperitoneal space.

Conclusion Robotic-assisted single-position lateral for multilevel circumferential lumbar interbody fusion is a safe and effective procedure in patients where lumbar stabilization is required. This technique provides patients with a faster recovery and low risk of complications.

Posted on

Can titanium surface technology reduce cost for biologics in anterior lumbar interbody fusion?

J Neurosurg Spine 41:589–595, 2024

Advances in surface architecture and technology have made interbody fusion devices more bioactive, with the hope of facilitating the fusion process more successfully. The advent of these increasingly bioactive implants may reduce reliance on more expensive biologics that have previously been used to achieve high fusion rates.

METHODS A retrospective review of prospectively collected data (August 2018–December 2019) was conducted of consecutively performed anterior lumbar interbody fusions in which an acid-etched, nanosurface-modulated, titanium interbody device packed only with corticocancellous allograft chips and local blood was used. Minimum follow-up was 1 year, and inclusion required available imaging and outcome metrics preoperatively and at 1 year. Fusion and subsidence were assessed via CT scans and/or dynamic radiographs. Health-related quality-of-life measures (Oswestry Disability Index [ODI], visual analog scale [VAS] back/leg) were collected pre- and postoperatively.

RESULTS In total, 55 patients met inclusion criteria (1 year of follow-up, available imaging, and outcome metrics). A total of 69 lumbar levels were treated in these 55 patients. The mean age was 67 ± 12.1 years, with 47% female patients. Roughly one-third (35%) had previous spine surgery, and approximately one-tenth (9.1%) had prior spinal fusion. A total of 20.6% were treated at multiple levels (mean levels per patient 1.2, minimum 1, maximum 3). The mean preoperative patient-reported outcomes were as follows: ODI 39.71 ± 18.15, VAS back 6.49 ± 2.19, and VAS leg 5.41 ± 2.71. One year after surgery, the mean improvements in patient-reported outcomes (vs preoperative scores) were as follows: ODI −22.9 ± 13.08 (p < 0.001), VAS back −3.75 ± 2.03 (p < 0.001), VAS leg −3.73 ± 2.32 (p < 0.001). All levels achieved fusion at 1 year postoperatively based on CT scans (65/69 levels) or dynamic radiographs (4/69 levels, change in score < 5% on flexion-extension radiographs). Four of the 65 levels were assigned to the grade 3 category according to a CT-based grading system, meaning cranial and caudal endplate bone apposition to the implant on both surfaces with no clear intervertebral bone connection through or around the implant. Sixty-one of 65 were found to have contiguous intervertebral bone bridging and thus were assigned to grade 1 (n = 54) or grade 2 (n = 7). Low-grade graft subsidence (Marchi grade 0 or I) occurred in 9 levels (13.0%) and high-grade subsidence (Marchi grade II or III) in 4 levels (5.8%). No patients required reoperation at the level of anterior lumbar interbody fusion and no radiographic or clinical evidence of pedicle screw loosening or failure was observed.

CONCLUSIONS The combination of advances in materials science and surface technology as demonstrated with a nanotechnology titanium cage resulted in the ability to obtain lumbar interbody fusion with allograft chips and local blood alone. Achieving high fusion rates with low-cost biologics/allograft provides for an attractive pathway toward reducing the cost of reconstructive spine care, and a potential incremental benefit for healthcare economics.

Posted on

Risk factors for vascular injuries in anterior lumbar interbody fusion

J Neurosurg Spine 41:17–23, 2024

Vascular injuries in anterior lumbar interbody fusion (ALIF) occur due to the vascular manipulation needed to achieve optimal disc space exposure. In this study, the authors aimed to evaluate intraoperative vascular injuries in patients undergoing single- and multilevel ALIF at a large tertiary academic center.

METHODS Prospectively collected data specifically addressing postoperative complications in patients who underwent ALIF by neurosurgery spine faculty working with a specialized vascular surgeon were retrospectively reviewed. Demographic characteristics and intraoperative data were collected. Patients were split into vascular injury and non–vascular injury groups. Outcome comparisons were conducted using the chi-square exact and Wilcoxon rank-sum tests for categorical and continuous data, respectively. Logistic regression was used to investigate associations with vascular injury, with univariate analysis first conducted to identify candidate associations. Based on these results, variables demonstrating a between-groups test statistic of p < 0.10 were included in the multivariate analysis to determine the independent predictors of vascular injuries.

RESULTS In total, 323 patients who underwent ALIF procedures were identified: 51% were male (n = 166) and 49% were female (n = 157). The mean age was 57.1 years, with 56% (n = 182) having undergone prior lumbar surgery. Vascular injuries were encountered intraoperatively in 7.1% (n = 23) of patients, and the majority (91% [n = 21]) involved the left common iliac vein. Patients with vascular injuries were statistically older (mean 63.6 vs 56.6 years), had greater incidence rates of coronary artery disease, opioid use, multilevel ALIF surgery involving the L2–3 level, and surgery involving multiple disc spaces, had more multilevel anterior instrumentation, and experienced greater blood loss during surgery and longer length of stay (all p < 0.05). Overall, there was 1 death (0.3%) secondary to aortic artery injury. Multivariate analysis identified opioid use, multilevel ALIF involving L2–3, and multiple interbodies as statistically independent predictors of vascular injury (all p < 0.05).

CONCLUSIONS Identifying patient risk factors can reduce the risk of vascular injuries in ALIF. Opioid use, multilevel ALIF involving L2–3, and multiple interbodies were independent predictors of vascular injuries in ALIF.

Posted on

A comparison of modern-era anterior lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion at the lumbosacral junction

J Neurosurg Spine 39:785–792, 2023

Interbody fusion is the primary method for achieving arthrodesis across the lumbosacral junction in the setting of degenerative pathologies, such as spondylosis and spondylolisthesis. Two common techniques are anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF). In recent years, interbody design and technology have advanced, and most earlier studies comparing ALIF and TLIF did not specifically assess the lumbosacral junction. This study compared changes in radiographic and clinical parameters between patients undergoing modern-era single-level ALIF and minimally invasive surgery (MIS) TLIF at L5–S1.

METHODS Consecutive patients who underwent single-segment L5–S1 ALIF or MIS TLIF performed by the senior authors over a 6-year interval (January 1, 2016–November 30, 2021) were retrospectively reviewed. Upright radiographs were used to determine pre- and postoperative lumbar lordosis, segmental lordosis, disc angle, and neuroforaminal height. Improvements in patient-reported outcome scores (Oswestry Disability Index and SF-36) were also compared.

RESULTS Overall, 108 patients (58 [54%] men, 50 [46%] women; mean [SD] age 57.6 [13.5] years) were included in the study. ALIF was performed in 49 patients, and TLIF was performed in 59 patients. The most common treatment indications were spondylolisthesis (50%, 54/108) and spondylosis (46%, 50/108). The cohorts did not differ in terms of intraoperative (p > 0.99) or postoperative (p = 0.73) complication rates. The mean (SD) hospital length of stay was significantly shorter for patients undergoing TLIF than ALIF (1.3 [0.6] days vs 2.0 [1.4] days, p < 0.001). Both techniques significantly improved L5–S1 segmental lordosis, disc angle, and neuroforaminal height (p ≤ 0.008). ALIF versus TLIF significantly increased mean [SD] segmental lordosis (12.5° [7.3°] vs 2.0° [5.7°], p < 0.001), disc angle (14.8° [5.5°] vs 3.0° [6.1°], p < 0.001), and neuroforaminal height (4.5 [4.6] mm vs 2.4 [3.0] mm, p = 0.008). Improvements in patient-reported outcome parameters and reoperation rates were similar between cohorts.

CONCLUSIONS When treating patients at a single segment across the lumbosacral junction, ALIF resulted in significantly greater increases in segmental lordosis, L5–S1 disc angle, and neuroforaminal height compared with MIS TLIF. Improvements in clinical parameters and reoperation rates were similar between the 2 techniques.

Posted on

OLIF versus ALIF: Which is the better surgical approach for degenerative lumbar disease?

European Spine Journal (2023) 32:689–699

The aim of this study was to compare the clinical and radiographical outcomes between OLIF and ALIF in treating lumbar degenerative diseases.

Methods We searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies. Changes in disc height (DH), segmental lordosis angle (SLA), lumbar lordosis (LL), visual analogue scale (VAS) score, and Oswestry disability index (ODI) between baseline and final follow-up, along with other important surgical outcomes, were assessed and analysed. Data on the global fusion rate and main complications were collected and compared.

Results Approximately, 2041 patients from 36 studies were included, consisting of 1057 patients who underwent OLIF and 984 patients who underwent ALIF. The results reveal no significant difference in DH, SLA, VAS score, and ODI between the two groups (all P > 0.05). The operation time, estimated blood loss, and length of hospital stay were also comparable between the two groups. Over 90% of the fusion rate was achieved in both groups. The OLIF group showed a higher complication rate than the ALIF group (OLIF 18.83% vs ALIF 7.32%).

Conclusions OLIF leads to a higher complication rate, with the most notable complication being cage subsidence. Both OLIF and ALIF are effective treatments for degenerative lumbar diseases and have similar therapeutic effects. ALIF was expected to be more expensive for patients because of the necessity of involving vascular surgeons.

Posted on

Radiographic comparison of L5–S1 lateral anterior lumbar interbody fusion cage subsidence and displacement by fixation strategy: anterior plate versus integrated screws

J Neurosurg Spine 38:126–130, 2023

OBJECTIVE The aim of this study was to radiographically compare cage subsidence and displacement between L5–S1 lateral anterior lumbar interbody fusion (ALIF) cages secured with an anterior buttress plate and cages secured with integrated screws.

METHODS Consecutive patients who underwent L5–S1 lateral ALIF with supplemental posterior fixation by a single surgeon from June 2016 to January 2021 were reviewed. Radiographs were analyzed and compared between the two groups based on the type of fixation used to secure the L5–S1 lateral ALIF cage: 1) anterior buttress plate or 2) integrated screws. The following measurements at L5–S1 were analyzed on radiographs obtained preoperatively, before discharge, and at latest follow-up: 1) anterior disc height, 2) posterior disc height, and 3) segmental lordosis. Cage subsidence and anterior cage displacement were determined radiographically.

RESULTS One hundred thirty-nine patients (mean age 60.0 ± 14.3 years) were included for analysis. Sixty-eight patients were treated with an anterior buttress plate (mean follow-up 12 ± 5 months), and 71 were treated with integrated screws (mean follow-up 9 ± 3 months). Mean age, sex distribution, preoperative L5–S1 lordosis, preoperative L5–S1 anterior disc height, and preoperative L5–S1 posterior disc height were statistically similar between the two groups. After surgery, the segmental L5–S1 lordosis and L5–S1 anterior disc heights significantly improved for both groups, and each respective measurement was similar between the groups at final follow-up. Posterior disc heights significantly increased after surgery with integrated screws but not with the anterior buttress plate. As such, posterior disc heights were significantly greater at final follow-up for integrated screws. Compared with patients who received integrated screws, significantly more patients who received the anterior buttress plate had cage subsidence cranially through the L5 endplate (20.6% vs 2.8%, p < 0.01), cage subsidence caudally through the S1 endplate (27.9% vs 0%, p < 0.01), and anterior cage displacement (22.1% vs 0%, p < 0.01).

CONCLUSIONS In this radiographic analysis of 139 patients who underwent lateral L5–S1 ALIF supplemented by posterior fixation, L5–S1 cages secured with an anterior buttress plate demonstrated significantly higher rates of cage subsidence and anterior cage displacement compared with cages secured with integrated screws. While the more durable stability afforded by cages secured with integrated screws suggests that they may be a more viable fixation strategy for L5–S1 lateral ALIFs, there are multiple factors that can contribute to cage subsidence, and, thus, definitive presumption cannot be made that the findings of this study are directly related to the buttress plate.

Posted on

Preoperative Duration of Symptoms Does Not Affect Outcomes of Anterior Lumbar Interbody Fusion

Neurosurgery 90:215–220, 2022

Previous studies have examined the impact of preoperative duration of symptoms (DOS) on lumbar spinal surgery outcomes although this has not been explored for anterior lumbar interbody fusion (ALIF).

OBJECTIVE: To assess the impact of preoperative DOS on patient-reported outcome measures (PROMs) of ALIF with posterior instrumentation.

METHODS: A database was retrospectively reviewed for ALIFs with posterior instrumentation. PROMs recorded at preoperative, 6-wk, 12-wk, 6-mo, and 1-yr postoperative timepoints in- cluded Visual Analog Scale back and leg, Oswestry Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and PROM Information System physical function. Achievement of minimum clinically important difference (MCID) was determined by com- paring differences in postoperative PROMs from baseline to established values. Patients were grouped based on preoperative DOS into <1-yr and ≥1-yr groups. Differences in PROMs were compared using a t-test, whereas MCID achievement used a χ2 test.

RESULTS: Fifty-three patients were included, with 20 in the <1-yrgroup and 33 in the ≥1-yr group. The most common diagnosis was isthmic spondylolisthesis. No significant preoperative differences were observed in any PROM. DOS groups demonstrated significantly different scores for SF-12 PCS at 6 wk (P = .049). No significant differences in MCID achievement were observed between groups for any PROM.

CONCLUSION: ALIF patients demonstrated similar levels of pain, disability, and physical function regardless of preoperative DOS, except for back pain and physical function at intermittent timepoints. MCID achievement did not differ based on DOS for all outcome measures.

Posted on

Lymphocele after anterior lumbar interbody fusion: a review of 1322 patients

J Neurosurg Spine 35:722–728, 2021

Anterior lumbar interbody fusion (ALIF) is an effective surgical modality for many lumbar degenerative pathologies, but a rare and infrequently reported complication is postoperative lymphocele. The goals of the present study were to review a large consecutive series of patients who underwent ALIF at a high-volume institution, estimate the rate of lymphocele occurrence after ALIF, and investigate the outcomes of patients who developed lymphocele after ALIF.

METHODS A retrospective review of the electronic medical record was completed, identifying all patients (≥ 18 years old) who underwent at a minimum a single-level ALIF from 2012 through 2019. Postoperative spinal and abdominal images, as well as radiologist reports, were reviewed for mention of lymphocele. Clinical data were collected and reported. RESULTS A total of 1322 patients underwent a minimum 1-level ALIF. Of these patients, 937 (70.9%) had either postoperative abdominal or lumbar spine images, and the resulting lymphocele incidence was 2.1% (20/937 patients). The mean ± SD age was 67 ± 10.9 years, and the male/female ratio was 1:1. Patients with lymphocele were significantly older than those without lymphocele (66.9 vs 58.9 years, p = 0.006). In addition, patients with lymphocele had a greater number of mean levels fused (2.5 vs 1.8, p < 0.001) and were more likely to have undergone ALIF at L2–4 (95.0% vs 66.4%, p = 0.007) than patients without lymphocele. On subsequent multivariate analysis, age (OR 1.07, 95% CI 1.01– 1.12, p = 0.013), BMI (OR 1.10, 95% CI 1.01–1.18, p = 0.021), and number of levels fused (OR 1.82, 95% CI 1.05–3.14, p = 0.032) were independent prognosticators of postoperative lymphocele development. Patients with symptomatic lymphocele were successfully treated with either interventional radiology (IR) drainage and/or sclerosis therapy and achieved radiographic resolution. The mean ± SD length of hospital stay was 9.1 ± 5.2 days. Ten patients (50%) were postoperatively discharged to a rehabilitation center: 8 patients (40%) were discharged to home, 1 (5%) to a skilled nursing facility, and 1 (5%) to a long-term acute care facility.

CONCLUSIONS After ALIF, 2.1% of patients were diagnosed with radiographically identified postoperative lymphocele and had risk factors such as increased age, BMI, and number of levels fused. Most patients presented within 1 month postoperatively, and their clinical presentations included abdominal pain, abdominal distension, and/or wound complications. Of note, 25% of identified lymphoceles were discovered incidentally. Patients with symptomatic lymphocele were successfully treated with either IR drainage and/or sclerosis therapy and achieved radiographic resolution.

Posted on

Is there a variance in complication types associated with ALIF approaches?

Acta Neurochirurgica (2021) 163:2991–3004

Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type.

Methods A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach.

Results A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05–0.21) and overall rates of complications (p = 0.05; CI = 0.00–0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = − 0.04–0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).

Conclusion Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

Posted on

Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease

Neurosurg Focus 49 (3):E2, 2020

In this study the authors compared the anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) techniques in a homogeneous group of patients affected by single-level L5–S1 degenerative disc disease (DDD) and postdiscectomy syndrome (PDS). The purpose of the study was to analyze perioperative, functional, and radiological data between the two techniques.

METHODS A retrospective analysis of patient data was performed between 2015 and 2018. Patients were clustered into two homogeneous groups (group 1 = ALIF, group 2 = TLIF) according to surgical procedure. A statistical analysis of clinical perioperative and radiological findings was performed to compare the two groups. A senior musculoskeletal radiologist retrospectively revised all radiological images.

RESULTS Seventy-two patients were comparable in terms of demographic features and surgical diagnosis and included in the study, involving 32 (44.4%) male and 40 (55.6%) female patients with an average age of 47.7 years. The mean follow-up duration was 49.7 months. Thirty-six patients (50%) were clustered in group 1, including 31 (86%) with DDD and 5 (14%) with PDS. Thirty-six patients (50%) were clustered in group 2, including 28 (78%) with DDD and 8 (22%) with PDS. A significant reduction in surgical time (107.4 vs 181.1 minutes) and blood loss (188.9 vs 387.1 ml) in group 1 (p < 0.0001) was observed. No significant differences in complications and reoperation rates between the two groups (p = 0.561) was observed. A significant improvement in functional outcome was observed in both groups (p < 0.001), but no significant difference between the two groups was found at the last follow-up. In group 1, a faster median time of return to work (2.4 vs 3.2 months) was recorded. A significant improvement in L5–S1 postoperative lordosis restoration was registered in the ALIF group (9.0 vs 5.0, p = 0.023).

CONCLUSIONS According to these results, interbody fusion is effective in the surgical management of discogenic pain. Even if clinical benefits were achieved earlier in the ALIF group (better scores and faster return to work), both procedures improved functional outcomes at last follow-up. The ALIF group showed significant reduction of blood loss, shorter surgical time, and better segmental lordosis restoration when compared to the TLIF group. No significant differences in postoperative complications were observed between the groups. Based on these results, the ALIF technique enhances radiological outcome improvement in spinopelvic parameters when compared to TLIF in the management of adult patients with L5–S1 DDD.

Posted on

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

Neurosurg Review (40) pp 67–81, 2017

In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010.

Surgical outcomes – as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) – were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes .

After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up.

In conclusion, LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.

Posted on

Outcomes of Anterior Lumbar Interbody Fusion Surgery Based on Indication: A Prospective Study

Outcomes of Anterior Lumbar Interbody Fusion Surgery Based on Indication- A Prospective Study

Neurosurgery 76:7–24, 2015

There is limited information on clinical outcomes after anterior lumbar interbody fusion (ALIF) based on the indications for surgery.

OBJECTIVE: To compare the clinical and radiological outcomes of ALIF for each surgical indication.

METHODS: This prospective clinical study included 125 patients who underwent ALIF over a 2-year period. The patients were evaluated preoperatively and postoperatively. Outcome measures included the Short Form-12, Oswestry Disability Index, Visual Analog Scale, and Patient Satisfaction Index.

RESULTS: After a mean follow-up of 20 months, the clinical condition of the patients was significantly better than their preoperative status across all indications. A total of 108 patients had a Patient Satisfaction Index score of 1 or 2, indicating a successful clinical outcome in 86%. Patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and scoliosis had the best clinical response to ALIF, with statistically significant improvement in the Short Form-12, Oswestry Disability Index, and Visual Analog Scale. Failed posterior fusion and adjacent segment disease showed statistically significant improvement in all of these clinical outcome scores, although the mean changes in the Short Form-12 Mental Component Summary, Oswestry Disability Index, and Visual Analog Scale (back pain) were lower. The overall radiological fusion rate was 94.4%. Superior radiological outcomes (fusion .90%) were observed in patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and failed posterior fusion, whereas in adjacent segment disease, it was 80%.

CONCLUSION: ALIF is an effective treatment for degenerative disk disease (with and without radiculopathy) and spondylolisthesis. Although results were promising for scoliosis, failed posterior fusion, and adjacent segment disease, further studies are necessary to establish the effectiveness of ALIF in these conditions.

Proudly powered by WordPress