Back pain outcomes after minimally invasive anterior lumbar interbody fusion: a systematic review

Abstract

OBJECTIVEMinimally invasive anterior lumbar interbody fusion surgery (MIS ALIF) is a technique that restores disc height and lumbar lordosis through a smaller exposure and less soft-tissue trauma compared to open approaches. The mini-open and laparoscopic assistance techniques are two main forms of MIS ALIF. The authors conducted a systematic review that sought to critically summarize the literature on back pain following MIS ALIF.METHODSIn March 2020, the authors searched the PubMed, Web of Science, and Cochrane Library databases for studies describing back pain visual analog scale (VAS) outcomes after MIS ALIF. The following exclusion criteria were applied to studies evaluated in full text: 1) the study included fewer than 20 patients, 2) the mean follow-up duration was shorter than 12 months, 3) the study did not report back pain VAS score as an outcome measure, and 4) MIS ALIF was not studied specifically. The methodology for the included studies were evaluated for potential biases and assigned a level of evidence.RESULTSThere were a total of 552 patients included from 13 studies. The most common biases were selection and interviewer bias. The majority of studies were retrospective. The mean sample size was 42.3 patients. The mean follow-up duration was approximately 41.8 months. The mean postoperative VAS reduction was 5.1 points. The mean VAS reduction for standalone grafts was 5.9 points, and 5.0 points for those augmented with posterior fixation. The most common complications included bladder or urinary dysfunction, infection, and hardware-related complications.CONCLUSIONSThis was a systematic review of back pain outcomes following MIS ALIF. Back pain VAS score was reduced postoperatively across all studies. The complication rates were low overall. MIS ALIF is safe and effective at reducing back pain in appropriate patient populations.

Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface

“…The ALIF technique has proven to be an effective method in treating degenerative or traumatic spinal instability by fusing the spine from an anterior retroperitoneal approach. 28 Advantages of ALIF surgery in particular include eliminating the need to manipulate the paraspinal musculature, which results in less dissection trauma, thus preserving vascular supply, 29 as well as providing the ability to place a large graft in the intervertebral space. 16 This large graft can allow for greater correction of coronal or sagittal imbalance and will cover a larger surface area of bone, which can result in a high fusion rate.…”

“…39 Complications reported in the literature by another systematic review included bladder or urinary dysfunction (2.5%), infection (2.4%), and hardware-related complications (2.2%). 28…”

Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis

“…Minimally invasive spine surgery (MISS) is increas-ingly recognized as an appealing alternative to open approaches. The typical advantages of MISS include faster postoperative recovery, decreased infection rates, reduced soft-tissue damage, and lesser postoperative pain [1][2][3][4]. The most widely-described MISS techniques (e.g., tubular microdiscectomy) are for posterior/posterolateral approaches.…”

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

“…The approach allows for a complete discectomy and placement of a large interbody cage, resulting in solid anterior column support and fusion rates in excess of 90% [4]. The ALIF has also been associated with improved patient-reported outcome measures [2,5].…”