Immediate Reciprocal Changes at Adjacent Level Following Single-Level Alif

Abstract

Objective : To assess the segmental sagittal parameters and the adjacent mobile segment after interbody fusion by anterior approach in single-level L5-S1. Methods : Retrospective study. Inclusion: Interbody fusion by anterior approach (10°/15° angle), due to DDD, low-grade spondylolisthesis and/or stenosis without prior lumbar fusion. Thirty-five cases were included (25 women; mean age 47±15 years). Analysis of lumbar radiographs were performed preoperatively and 3 months after surgery. The following parameters were evaluated: lumbar lordosis; segmental lordosis L4-L5 and L5-S1; sacral and L5 slope. Two independent evaluators made the measurements. Student's t test was used. Results : There was correction of lordosis at the L5-S1 level, from an average of 19° prior to surgery to 28° three months after surgery (p<0.001). It was observed reduction of the L4-L5 angle from 17° to 14° (p <0.001). Moreover, there was a small, but statistically significant, reduction of L5 inclination from 17 ° to 13 ° (p=0.007) and increase in the sacral slope from 37° to 40° (p=0.002). The change of total lumbar lordosis was not significant: 52° versus 53° (p=0.461). Before surgical correction, lordosis of the L5-S1 level contributed, on average, 37% of lumbar lordosis, and after, 54% (p<0.001). The L4-L5 level accounted for 34% and decreased to 24% (p<0.001). Conclusion : In the group studied, it was observed a decrease in lordosis of the adjacent mobile level following the treatment of the degenerate level by anterior interbody fusion and concomitant increase in lordosis.

Rational decision making in a wide scenario of different minimally invasive lumbar interbody fusion approaches and devices

“…Among them are several degenerative pathologies that affect intervertebral discs, leading to disc collapse, discogenic pain, low-grade spondylolisthesis, disc herniation and pseudoarthrosis (16)(17)(18)(19). A great advantage of ALIF is the opportunity to restore disc height and gain lordosis (20,21). In revision surgeries, it avoids scars from previous surgery.…”

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

“…The advantages of the anterior approach (anterior lumbar interbody fusion, ALIF) include the possibility of disc space re-expansion, lumbar lordosis recovery, indirect decompression, prevention of damage to posterior structures (paravertebral and osteoligamentous muscle) and morbidity and immediate perioperative pain reduction. 1 , 2 , 3 , 4 , 5 …”