Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Abstract

The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930's, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). More recently, the lateral trans-psoas approach termed extreme, direct or lateral lumbar interbody fusion (XLIF, DLIF, LLIF) is gaining widespread popularity.The aim of this paper is to compare the approaches, advantages and disadvantages of ALIF and XLIF for L4/5 interbody fusion based on relevant literature.

Anterior and Lateral Lumbar Interbody Fusion With Supplemental Interspinous Process Fixation: Outcomes from a Multicenter, Prospective, Randomized, Controlled Study

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, given the inherent axial and coronal stability of a large anterolateral cage, the structural necessity of invasive/extensive PSF in ALIF/LLIF has come into question, particularly in single-level application. Accordingly, a growing body of literature exploring less invasive and less demanding alternatives for secondary stability in ALIF/LLIF has emerged.…”

Nursing care of the patient undergoing lumbar spinal fusion

“…The anterior approach avoids dissection of the paraspinal musculature and posterior ligaments and is associated with earlier ambulation, less postoperative pain, and shorter inpatient length of stay than the posterior approach. [14,15] However, the anterior approach is also associated with increased risk of vascular complications, visceral injury, retrograde ejaculation, and sympathetic dysfunction because of the proximity of the major vessels, abdominal organs, and hypogastric plexus to the surgical dissection. [13,16] Severe obesity or extensive scarring from previous abdominal surgery may preclude the anterior approach.…”

“…However, XLIF is less invasive than ALIF and does not necessitate retraction of the major vessels or sympathetic chain. [15] Retroperitoneal scarring or anomalous vascular anatomy, as well as the need to incorporate L5-S1 into the fusion, may preclude XLIF. [16] 5.5 Minimally invasive surgery Minimally invasive surgery (MIS) has emerged as a popular alternative to traditional open lumbar fusion.…”

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

“…Surgical lumbar interbody fusion is an effective treatment option to stabilize the painful moving segment, and may provide indirect decompression of the neural elements, correct deformity, and restore lordosis [2][3][4][5] . Many lumbar interbody fusion techniques have been developed and popularized, including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF).…”