ALIF- und PLIF-Interposition bei low-grade isthmischen Spondylolisthesen L5/S1

Abstract

Both treatment and fusion techniques (ALIF/PLIF) were able to achieve a significant pain relief and reduced consumption of pain medication postoperatively. The recovery period was similar in both groups, but there were differences regarding the date of return to work, hospitalization, duration of surgery and ODI score. Neither of the two methods could show a definite advantage.

Comparison of ALIF and PLIF in Isthmic Lumbosacral Spondylolisthesis. A Multicenter Surveillance Study of 602 cases from the German Spine Registry (DWG Register)

“…7,16,24 Moreover, this may allow accelerated postoperative mobilization by reducing postoperative pain. 7,9 Disadvantages of ALIF compared with PLIF are mostly due to the anterior approach itself. The dissection requires preparation and mobilization of the iliac vessels, which can lead to deep venous thrombosis as well as pulmonary embolism.…”

“…2 The patients' symptoms include lower backpain, radicular pain, and stiffness, which can impair an individual's ability to work and diminish quality of life. [7][8][9] The radicular pain can be caused by a variety of reasons, including compression of the nerve root by fibrocartilaginous tissue, nerve root traction from the listhesis, or disk bulges, [2][3][4] while lower backpain is mostly caused by lumbar hyperlordosis and malalignment, which leads to muscle strain. 3 The spondylolisthesis progresses further because of hypermobility in the segment and accelerated degeneration.…”

“…Two of these options are posterior lumbar interbody fusion (PLIF) and anterior lumbar interbody fusion (ALIF). 2,4,6,7,[12][13][14][15] The goal of all approaches is to decrease the motion of the painful segments by fusion and thereby leading to pain relief. 7,10 In addition, the olisthesis could be corrected, the lordosis restored, and the neurologic structures decompressed.…”

“…1,4,7,9,10,15 ALIF and PLIF have acceptable fusion rates and are each associated with a unique set of benefits and risks. 7,9,12,17 Advantages of ALIF are a maximum removal of the disk under direct visualization 3 by a wider access to the disk space and thus better restoration of the disk space as well as of the whole lumbar lordosis. 18,19 In addition, there is minimal trauma to the dorsal muscles and ligaments and by indirect compression there is a low risk of neural injury.…”

“…[2][3][4][5][6] The etiology of isthmic spondylolisthesis is still not fully understood and is thought to be multifactorial in origin with genetic, endocrine, and mechanical factors playing a role. [2][3][4]6,7 While males are twice as likely to be affected, the slippage progresses more frequently in females. 2 The patients' symptoms include lower backpain, radicular pain, and stiffness, which can impair an individual's ability to work and diminish quality of life.…”