Stand-alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine

Abstract

4.

Artrodese lombar intersomática anterior multinível combinada com estabilização posterior em discopatia—Análise clínico-funcional prospectiva

“…Some studies demonstrate that standalone instrumented ALIF without posterior stabilization does not yield significant differences in terms of clinical-functional and radiographic outcomes compared with circumferential lumbar interbody fusion, so a second surgery can be avoided in cases with no need of posterior decompression. 3 6 7 9 10 11 18 19 However, other studies showed superior union rates for instrumented ALIFs combined with posterior fixation, demonstrating that, although ALIF fixation with an anterior plaque or cage-integrated screws significantly increases stability, it is still inferior compared with the posterior instrumentation. 20 21 22 23 24 25 Moreover, the additional stability offered by posterior fixation or interbody fusion may probably contribute to decrease the intensity or even avoid symptoms in case of a nonunion ALIF, allowing these lack of fusions to be tolerated or asymptomatic.…”

“…The use of Infuse® (Medtronic, Fridley, MN, USA) also avoids morbidity and possible complications during the obtainment of an iliac crest autograft. 3 10 Although patients with previous PLIF nonunions had less favorable clinical-functional scores, the review using another approach (anterior approach) and ALIF resulted in very satisfactory outcomes. 2 26…”

“…Thus, theoretically, there is less bleeding, which may allow a faster postoperative pain relief (reducing the need for painkillers) and functional improvement (with shorter hospital stay), as well as earlier spine stability, because it does not interfere with the supporting musculature. 3 5 6 8 9 10 Moreover, the anterior approach neither implies in the removal of posterior spinal elements, nor in the entry into the spinal canal or in the manipulation of the spinal roots to access the disc space; as such, it decreases the risk of iatrogenic injury and of complications in these important structures compared with the posterior approaches. 3 6 8…”

Evaluation of Two Novel Integrated Stand-Alone Spacer Designs Compared with Anterior and Anterior-Posterior Single-Level Lumbar Fusion Techniques: An <italic>In Vitro</italic> Biomechanical Investigation

“…Conversely, the ALIF approach is also associated with some noted disadvantages which include injury to the great vessels and to the presacral plexus resulting in retrograde ejaculation and sterility [ 19 20 21 ]; furthermore, anatomic variance of the iliac vessels may contribute to intraoperative complications [ 22 23 ]. In response, zero-profile integrated ALIF spacers with integrated screws have been developed to minimize surgical morbidity while providing sufficient stability (in spite of removal of the anterior tension band) to achieve fusion reliably [ 24 25 ].…”

Bowel injury in lumbar spine surgery: a review of the literature

“…Recent advances in spinal instrumentation have led to the development of several new minimally invasive surgical (MIS) approaches such as anterior lumbar interbody fusion (ALIF), direct or indirect lateral interbody fusion (LIF), and transforaminal lumbar interbody fusion (TLIF). These procedures contribute to minimizing the size and number of incisions and the extent of tissue retraction, as well as reducing surgical time, blood loss, and length of hospital stay (5)(6)(7)(8)(9)(10). However, even with these new techniques and safeguards, cases of bowel perforation injury are reported in the current literature.…”