Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results with a Two-Year Follow-Up

Lämmli, J; Whitaker, Camden; Moskowitz, Alan; Adams, Brent D.; Duong, Jennifer; Dong, Frank; Wooley, Paul H.; Ablah, Elizabeth; Felts, Lara; Konye, Geoffrey

doi:10.1016/j.spinee.2012.08.042

Cited by 5 publications

(12 citation statements)

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“…Subjects who underwent long fusion did not have an increased frequency of minor complications, such as persistent severe pain, hematoma, or surgical site infection when compared to subjects who underwent short fusion (1-or 2-level fusion). 4,5 However, the pain level improvement for this study was only 2.1 for one-year follow-up and 2.6 for two-year follow-up, which was significantly less than the improvement seen in 1-and 2-level fusions at two-year follow-up (3.3). 4 Gains in functional outcomes were similar to those undergoing short fusions and similar percentages of patients undergoing long fusion improved or maintained functionality compared with those who had shorter fusions (current study: one-year follow-up: 15% difference, two-year follow-up: 22% difference, previous study: 4 17% difference).…”

Section: Outcomes In Combined Anterior and Posterior Fusion Continuedcontrasting

confidence: 66%

“…4,5 However, the pain level improvement for this study was only 2.1 for one-year follow-up and 2.6 for two-year follow-up, which was significantly less than the improvement seen in 1-and 2-level fusions at two-year follow-up (3.3). 4 Gains in functional outcomes were similar to those undergoing short fusions and similar percentages of patients undergoing long fusion improved or maintained functionality compared with those who had shorter fusions (current study: one-year follow-up: 15% difference, two-year follow-up: 22% difference, previous study: 4 17% difference). However, patients undergoing longer fusion had overall higher pre-and post-operative disability compared to those who underwent short fusion (current study: pre 53%, post 1-yr 37% and 2-yr 30%; previous study: pre 44%, post 27%).…”

Section: Outcomes In Combined Anterior and Posterior Fusion Continuedcontrasting

confidence: 66%

“…10,11 For 1-and 2-level disease, arthrodesis with an anterior-only or 360˚ fusion has been shown to be safe and successful in improving pain and function. 3,4,12 However, studies on longer fusions for DDD have been scarce and the results less predictable. 3,8,9 This study indicates that patients who undergo combined ALIF and posterior spinal fusion for 3and 4-level DDD have, on average, significant improvement in both function and pain after one and two years post-operative.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Lumbar spinal fusion improves pain and function in patients with DDD who have failed non-operative treatment, but remains controversial as literature is limited and has focused mainly on 1-and 2-level procedures. [2][3][4][5] With improvement of surgical approach, fusion techniques, and patient selection, surgical treatment has shown improvement in pain and disability. 2,6 Despite some clinical success, concern remains over complications, cost, adjacent segment disease, and question of improvement over non-operative treatment.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Haskins

Moskowitz

Lämmli

et al. 2016

kjm

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Introduction. This study reported the clinical and functionaloutcomes in a consecutive series of patients with3- or 4-level degenerative disc disease (DDD) betweenvertebral levels L2 to S1, who were treated with combinedanterior lumbar interbody fusion (ALIF) and posteriorspinal fusion at one-year and two-year follow-ups. Methods. A retrospective chart review was performed on allpatients who underwent long segment fusion for DDD by asingle surgeon between August 2002 and January 2012. Fiftyfivepatients were identified and 32 had complete charts for review(14 had one-year follow-up and 18 two-year follow-up).In addition to demographic data, disability (Oswestry DisabilityIndex, ODI), pain level (Visual Analog Scale, VAS), andflexion-extension range-of-motion were measured pre- andpost-operatively. Operative data also were collected, includingoperative time, blood loss, surgical implants used, surgicalapproach, operative levels treated, and complications.Results. Both VAS and ODI improved significantly postoperatively.The average VAS score improved from 6.5 ± 1.5(range: 4 - 9) to 4.4 ± 1.7 (range: 2 - 7) for one-year follow-up,and 7.0 ± 1.8 (range: 4 - 10) to 4.4 ± 2.6 (range: 1 - 9) for twoyearfollow-up. For one-year follow-up, the average ODI scoreimproved from 53 ± 19% (range: 18 - 70%) to 37 ± 17% (range:12 - 64%), and for two-year follow-up, the average improvedfrom 53 ± 18% (range: 18 - 80%) to 31 ± 24% (range: 2 - 92%).The level of improvement in pain and function was similar topreviously published data for 1- and 2-level fusions, but overallpain and function scores were worse in this study group. Conclusions. Arthrodesis for 3- and 4-level DDD is, on average,a successful surgery that shows clinically significantimprovements in function and pain similar to fusionfor 1- and 2-levels with low rates of re-operation. Patientswith involvement of 3- or 4-levels have higher disabilityand pain both pre- and post-operatively compared to shorterfusion level involvement. KS J Med 2016;9(3):50-53.

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Section: Outcomes In Combined Anterior and Posterior Fusion Continuedcontrasting

confidence: 66%

Section: Outcomes In Combined Anterior and Posterior Fusion Continuedcontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Haskins

Moskowitz

Lämmli

et al. 2016

kjm

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“…An advantage of decompression surgery is encountering and recognizing compressed nerve tissue in the stenotic region under direct vision; whereas various adverse effects include hematoma, dural tear and liquorrhea, iatrogenic intervertebral instability, infection, and massive postoperative bleeding 3,4) . Complications such as deep venous thrombosis and intraoperative damage to ureters and sympathetic nerves have been reported in cases of anterior lumbar interbody fusion [5][6][7] . In addition, a surgical plan for patients with adult spinal deformity is required to obtain adequate global spinal balance.…”

Section: Introductionmentioning

confidence: 99%

Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis

Ebata

Ohba

Haro

2018

Spine Surg Relat Res

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Abstract:Introduction: Through an extreme lateral retroperitoneal and transpsoas approach to intervertebral disc and fusion surgery, a large lordosis cage can be placed for solid and stable intervertebral fusion and to provide strong anterior support, disc height restoration, favorable alignment, and indirect nerve decompression. However, appropriate placement of the interbody cage remains insufficiently researched. We sought to determine both appropriate cage placement as well as other factors affecting nerve decompression in extreme lateral interbody fusion (XLIF) surgery.Methods: We included 53 consecutive patients suffering from lumbar degenerative diseases with an indication for XLIF. Radiographic analysis using a sagittal computed tomography (CT) and axial magnetic resonance imaging (MRI) views was conducted to determine intervertebral disc height and angle, degree of disc bulging and thickness of the flavum, the area of the dural tube, cage height, pre-and postoperative disc bulging, change of disc bulging after surgery, cage subsidence, and cage placement at the rostral and caudal endplates.Results: Intervertebral disc height and angle were significantly increased at all levels (L2/3, 3/4, 4/5) (p < 0.05). The area of the dural tube was significantly increased (p < 0.05), whereas the degree of disc bulging and thickness of the flavum were significantly decreased at all disc levels (p < 0.05). The enlarged area of the dural tube showed significant correlation with increased disc height (p = 0.019), preoperative flavum thickness (p = 0.008), change of flavum thickness (p < 0.0001), and cage placement at the rostral endplate (p = 0.014).Conclusions: A decrease in flavum buckling is more important than disc protrusion as a consideration for obtaining indirect decompression. Central placement may be advantageous for indirect decompression.

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Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Vieli¹,

Staartjes²,

Eversdjik³

et al. 2019

Cureus

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IntroductionAs a possible treatment option for chronic lower back pain (CLBP) due to single-level degenerative disc disorder (DDD), the efficacy of anterior lumbar interbody fusion (ALIF) has been reviewed various times in the existing literature. Nevertheless, a scarcity of data exists pertaining to ALIF procedures carried out in a short-stay setting using an Enhanced Recovery after Surgery (ERAS) protocol, particularly concerning the safety.MethodsProspectively collected data are analyzed to study the efficacy and safety of short-stay ERAS ALIF in treatment of single-level DDD. Visual Analog Scale (VAS) in both back and leg pain along with the Oswestry Disability Index (ODI) were used to collect measure outcomes. The primary endpoint was a minimum clinically important difference (MCID) of ≥30% for the ODI at 12 months.ResultsForty-four patients underwent surgery after failed long-term conservative treatment. MCID was achieved in 78%. Age was the only significant factor in association with MCID (p = 0.03), while gender, Modic changes, results of prognostic tests, prior surgery and smoking status had no significant influence on either MCID or change scores for any outcome measure. One complication in the form of transient new radiculopathy occurred in one patient (2.3%).ConclusionWith overall positive outcomes in terms of both efficacy and safety, an ALIF procedure with subsequent implementation of an ERAS protocol in a short-stay setting can be an option for strictly selected patients with CLBP. Further study, however, possibly with a larger sample size, would be necessary to substantiate these findings.

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Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results with a Two-Year Follow-Up

Cited by 5 publications

References 0 publications

Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis

Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

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