Comparison of Different Approaches in Lumbosacral Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

Abstract

We aimed to systematically review the literature to analyze the differences in posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion (ALIF), and transforaminal lumbar interbody fusion (TLIF), focusing on the complications, risk factors, and fusion rate of each approach. Spinal fusion surgery is a well-established surgical procedure for a variety of indications, and different approaches developed. The various approaches and their advantages, as well as approach-related pathology and complications, are well investigated in spinal surgery. Focusing only on lumbosacral fusion, the comparative studies of different approaches remain fewer in numbers. We systematically reviewed the literature on the complications associated with lumbosacral interbody fusion. Only the PLIF, ALIF, or TLIF approaches and studies published within the last decade (2007–2017) were included. The exclusion criteria in this study were oblique lumbar interbody fusion, extreme lateral interbody fusion, more than one procedure per patient, and reported patient numbers less than 10. The outcome variables were indications, fusion rates, operation time, perioperative complications, and clinical outcome by means of Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopaedic Association score. Five prospective, 17 retrospective, and two comparative studies that investigated the lumbosacral region were included. Mean fusion rates were 91,4%. ALIF showed a higher operation time, while PLIF resulted in greater blood loss. In all approaches, significant improvements in the clinical outcome were achieved, with ALIF showing slightly better results. Regarding complications, the ALIF technique showed the highest complication rates. Lumbosacral fusion surgery is a treatment to provide good results either through an approach for various indications as causes of lower back pain. For each surgical approach, advantages can be depicted. However, perioperative complications and risk factors are numerous and vary with ALIF, PLIF, and TLIF procedures, as well as with fusion rates.

Invasive dental procedures as risk factors for postoperative spinal infection and the effect of antibiotic prophylaxis

“…Postoperative infection is one of the most common and serious complications following spinal surgery. The incidence of this complication reported in recent studies ranged from 0.7% to 12% (Olsen et al, 2008;Ter Gunne & Cohen, 2009;Veeravagu et al, 2009;Fei et al, 2016;Lenz et al, 2021). Known risk factors vary, including old age, male sex, and long operation time, and it has been reported that the postoperative infection rate is 1.24-2.15 times higher in cases involving the use of instrumentation than in cases not involving the use of instrumentation (Veeravagu et al, 2009;Fei et al, 2016).…”

Metal failure and nonunion at L5-S1 after long instrumented fusion distal to pelvis for adult spinal deformity: Anterior versus transforaminal interbody fusion

“…Achieving solid fusion at the lumbosacral junction, L5-S1, remains a challenge, especially in a long instrumented fusion to the sacrum. [1][2][3][4] The L5-S1 segment has unique anatomical characteristics such as poor bone quality of the sacrum, complexity of the sacral anatomy, and an anterior inclination. This makes the fixation at the lumbosacral junction potentially weak during the fusion process, thereby increasing the risk of pseudoarthrosis at this segment.…”

Anterior Thigh Pain Following Minimally Invasive Oblique Lateral Interbody Fusion: Multivariate Analysis from a Prospective Case Series

“…Lateral interbody fusion (LIF) using a lateral access is a widely used surgical technique for various lumbar degenerative diseases, with proven efficacy and safety. 1) In spinal stenosis, LIF can indirectly decompress the spinal canal by restoring the disc height and reducing spondylolisthesis. 2) LIF is also a powerful surgical tool for adult spinal deformity correction.…”