Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion

Abstract

The goal of this study was to evaluate the impact of anterior lumbar interbody fusion (ALIF) on L5-S1 level for restitution of distal segmental lordosis and to investigate its consequences on spino-pelvic parameters and the global sagittal balance. Overview of Literature: Lumbar surgery must be adapted to the spinal morphology in order to restore an adequate relation between pelvic and spinal parameters and especially to the pelvic incidence. Methods: An observational, prospective study was conducted between January 2013 and May 2017. Eighty-six patients were treated by L5-S1 ALIF procedure regardless of disc replacement above L5-S1 level. Thirty-seven patients were included and subset analyses were performed on 25 patients operated on an isolated ALIF L5-S1 (group 1), and 12 patients with hybrid surgery consisting of an L5-S1 ALIF procedure and a L4-L5 lumbar disc replacement (group 2). Clinical parameters were analyzed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at M0 (preoperative) and M12 (12 months). Lumbo-pelvic parameters were assessed on a standing full-spine X-ray, preoperatively and at M12 after surgery. Results: We observed a significant evolution of L1-S1 lumbar lordosis (p<0.001) with a significant increase of the distal arch L4-S1 lordosis (p<0.001) and decrease of the proximal arch lordosis (p=0.03). Preoperatively, 27% of the patients were unbalanced. Significant variation in sagittal balance parameters was observed, with a decrease of the sagittal vertebral axis (p<0.001). VAS and ODI improved significantly but no correlation was found. An evolution in the same direction was found in the two subgroup analyses. Conclusions: ALIF procedure on L5-S1 level allowed a reconstruction of lumbosacral segmental lordosis, modification of global lordosis, without variation of spino-pelvic parameters except an improvement in sagittal balance.

ALIF Versus TLIF for L5-S1 Isthmic Spondylolisthesis: ALIF Demonstrates Superior Segmental and Regional Radiographic Outcomes and Clinical Improvements Across More Patient-reported Outcome Measures Domains

“…Notwithstanding this consideration, we feel that the inclusion of clinical outcomes is valuable and insightful in the overall assessment of ALIF and TLIF techniques. From a radiographic standpoint, we were limited in our analysis to assessing segmental and regional lumbar lordosis; in the setting of differential effects on pelvic incidence and pelvic tilt between TLIFs and ALIFs reported in the literature, [27][28][29] future work might entail obtaining these measurements at longer-term follow up for comparison. The temporal nature of this work, with cases confined to surgical procedures performed within the last 4 to 5 years, is advantageous in that it ensures relevance to the current surgical environment and obviates concerns around secular trends.…”

Venous anatomy of the lumbar region applied to anterior lumbar interbody fusion (ALIF): Proposal of a new classification

“…Moreover, spine surgery, and its minimally invasive form of implementation, have increased its frequency as a substantial treatment alternative over the past decade [ 10 , 11 , 15 ]. The decrease in the number of complications for the patient, the shorter hospital stay and surgical time, the relevant results, and the economic impact of this type of techniques, has allowed their use for the management of different spine pathologies [ 1 , 7 , 8 , 10 ], still needing tools that allow improving the optimal selection of the patients in order to improve their outcomes.…”

“…Two neurosurgeons specializing in spine surgery (MB, RD) performed the procedure using an extraperitoneal technique [8] , inserting an artificial disc in the created space. The collection of the different essential data was carried out by searching our institution medical history registration system, and a radiographic analysis with measurement of coronal and sagittal alignment parameters was also performed [15] .…”