Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 – What Is the Best Way to Restore a physiological Alignment?

Platz, Uwe; Halm, H.; Thomsen, B.; Pécsi, Ferenc; Köszegvary, M.; Bürger, Nina; Berlin, Clara; Quante, Markus

doi:10.1055/a-1560-3106

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…13 A separate study by Kim et al 12 Previous literature has illustrated that ALIF demonstrates superior segmental and regional lordosis correction compared with TLIF. [23][24][25] Greater lordotic correction may allow for decreased rates of adjacent segment degeneration among TLIF patients, as reported by Lee et al 26 Of note, our PROM scores and MCID achievement rates were equal in the past 12 weeks, suggesting that improvements in lordosis from ALIF may not necessarily implicate superior improvements in quality-of-life outcomes. This concept is closely related to statements by Horsting et al, 27 which note that radiographic adjacent segment disease may not influence clinical outcome scores.…”

Section: Discussionsupporting

confidence: 64%

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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Introduction:Limited studies have compared minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with anterior lumbar interbody fusion (ALIF) for the treatment of isthmic spondylolisthesis. This study aims to compare perioperative variables, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates between these surgical approaches.Methods:Patients with isthmic spondylolisthesis undergoing primary, single-level MIS TLIF or ALIF were identified in a surgical database. Patients were divided into MIS TLIF and ALIF cohorts. Demographics and perioperative characteristics were collected and compared between groups using the chi square test or Student t-test. PROMs including the Patient-Reported Outcomes Measurement Information System Physical Function, 12-Item Short Form Physical Composite Score, visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index were collected at preoperative, 6-, 12-week, 6-month, 1-, and 2-year time points. Mean PROMs were compared using the Student t-test for independent samples. MCID attainment was determined using established values in the literature; achievement rates by grouping were compared using chi square analysis.Results:One hundred seventy-one patients were included, 121 MIS TLIF and 50 ALIF. No demographic differences were observed. Mean surgical times were 139.7 minutes (MIS TLIF) and 165.5 minutes (ALIF) (P < 0.001). No other perioperative differences were observed. Mean estimated blood loss values were 63.8 mL (MIS TLIF) and 73.7 mL (ALIF). Mean postoperative lengths of stay were 43.9 hours (MIS TLIF) and 42.5 hours (ALIF). Mean PROMs did not markedly differ among groups at any time point. MCID attainment was markedly higher among MIS TLIF patients for the Oswestry Disability Index at 6 weeks (P = 0.046) and 12 weeks (P = 0.007), Patient-Reported Outcomes Measurement Information System Physical Function at 12 weeks (P = 0.015), and VAS leg at 6 weeks (P = 0.031) and 12 weeks (P = 0.045). No other notable differences were observed among MCID achievement by grouping.Discussion:While single-level ALIF demonstrated markedly higher surgical times, other perioperative characteristics and PROMs were comparable among ALIF and MIS TLIF patients. Although MCID achievement rates were generally lower for disability and leg pain among ALIF patients, significance was not reached at 6 months, 1 year, or during the overall postoperative period after fusion.

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Section: Discussionsupporting

confidence: 64%

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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“…A recent study [ 84 ] by our team comparing MIS-TLIF to ALIF at L5–S1 discovered that ALIF patients on average experienced more favorable postoperative clinical outcomes in physical function, back pain, and leg pain, as well as significantly fewer incidences of postoperative fever. The ALIF is widely considered to be particularly suitable for lordosis restoration at L5–S1 [ 85 ], due to its increased and direct vertebral access window, allowing for implantation of a larger interbody cage. Open TLIFs also have potential for considerable lordotic restoration, accomplishing comprehensive bilateral anterior column stabilization through a unilateral approach [ 86 ].…”

Section: In the Present: Characterizing The Mis-tlifmentioning

confidence: 99%

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2022

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The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

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“…Primary low back pain is primarily targeted through conservative treatment, while surgical treatment aims to address secondary low back pain, or primary cases that do not respond to conservative measures [3]. Traditional lumbar interbody fusion/arthrodesis (LIF) is a treatment option that utilizes posterior or anterior internal fixation to stabilize painful motion segments, restore lumbar physiological lordosis, correct deformities, and provide indirect decompression [4]. Currently, various surgical approaches have been developed for lumbar interbody fusion, including anterior LIF (ALIF), posterior LIF (PLIF), transforaminal LIF (TLIF), extreme or lateral LIF (XLIF/LLIF), oblique LIF (OLIF), and minimally invasive TLIF (MIS-TLIF) [5].…”

Section: Introductionmentioning

confidence: 99%

Research Progress in Lumbar Interbody Fusion (LIF) Techniques and Bone Biomaterials

2023

FMSR

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This paper aims to review recent research progress in lumbar interbody fusion (LIF) techniques and bone biomaterials for treating low back pain resulting from lumbar instability and/or deformity. A comprehensive search was conducted in PubMed, Science Citation Index-Expanded (SCI-E), and SpringerLink databases from their inception until April 2023. The search focused on relevant articles published within the past five years, using keywords such as lumbar fusion approach, lumbar interbody fusion cage, lumbar fusion stem cells, lumbar fusion biomaterials, and bone biology of lumbar fusion. Currently, lumbar interbody fusion techniques encompass posterior, anterior, lateral, oblique, and minimally invasive approaches. The transforaminal oblique lumbar fusion approach is gaining popularity due to its ability to minimize paraspinal muscle dissection and nerve traction. Despite advancements in surgical techniques, the incidence of fusion failure after LIF remains high, ranging from 7% to 20%, and is even higher in patients with osteoporosis. This review also discusses the improvement of fusion materials properties and the development of new bone biological products incorporating nanomaterials to enhance the release of effective osteogenic proteins and mesenchymal stem cells for promoting lumbar interbody fusion. Significant advancements have been made in surgical techniques for LIF over the past few decades. However, postoperative nonfusion continues to be a major challenge. Future solutions are expected to arise through the development of more efficient surgical techniques, fusion cages, and bone biomaterials.

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Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 – What Is the Best Way to Restore a physiological Alignment?

Cited by 8 publications

References 23 publications

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

Research Progress in Lumbar Interbody Fusion (LIF) Techniques and Bone Biomaterials

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