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Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months

STUDY DESIGN: Prospective cohort study comparing evaluations of single-level anterior lumbar interbody fusion (ALIF) versus anteroposterior lumbar fusion (APLF). OBJECTIVE: To clinically and radiologically compare the outcome after angle-stable, locked, stand-alone ALIF with that obtained after APLF, in cases with degenerative disc disease (DDD). SUMMARY OF BACKGROUND DATA: Fusion rates have been reported to be highest after interbody fusion with transpedicular fixation. However, transpedicular fixation is linked to significant damage of the paravertebral muscles, to screw displacement-related neurological and vascular complications, and to an increased rate of adjacent segment degeneration. When performed as a stand-alone procedure, the disadvantages of transpedicular fixation can be completely avoided by ALIF. METHODS: Eighty patients with chronic low-back pain due to a single-level DDD (Modic >/=2) and facet joint arthritis (Fujiwara >/=3) were enrolled in this study. Forty patients received an anteroposterior fusion (ALIF with transpedicular fixation: APLF group) and 40 patients (ALIF group) were treated with a stand-alone ALIF using the Synfix-LR device. At 7 days, 3, 6, 12, and 24 months, and at a mean follow-up of 41 months, patients were clinically (visual analog scale, Oswestry Low Back Pain Disability Index, satisfaction) and radiologically (x-ray, and at 12 months, thin-slice computed tomography) compared. RESULTS: Blood loss and duration of surgery were significantly lower in the ALIF group (P<0.001). Visual analog scale and Oswestry Low Back Pain Disability Index improved significantly over time (analysis of variance, P<0.001) in both groups, but both scores were significantly better in ALIF group (analysis of variance, P<0.001). Patients' satisfaction consistently ranked higher in the ALIF group (P=0.042 at 12 mo). No significant difference was found in the fusion rate throughout the study. CONCLUSIONS: Stand-alone ALIF leads to better clinical results than APLF, without differences in fusion rates after 41 months. Therefore, when a posterior approach is not needed for decompression or reposition, we suggest performing a stand-alone ALIF in cases with single-level DDD Keywords : Adult,Aged,analysis,Analysis of Variance,Back Pain,blood,Bone Screws,Cohort Studies,complications,diagnostic imaging,Female,Follow-Up Studies,Germany,Humans,instrumentation,Intervertebral Disc Degeneration,Low Back Pain,Lumbar Vertebrae,Male,methods,Middle Aged,Pain,Pain Measurement,Patient Satisfaction,Prospective Studies,Radiography,Spinal Fusion,surgery,Time,Treatment Outcome,, Anterior,Versus,Anteroposterior,Lumbar,Interbody, greater occipital nerve block technique

Date of Publication : 2012 Oct

Authors : Strube P;Hoff E;Hartwig T;Perka CF;Gross C;Putzier M;

Organisation : Center for Musculoskeletal Surgery, Clinic for Orthopaedics, Charite-University Medicine Berlin, Germany. patrick.strube@charite.de

Journal of Publication : J Spinal Disord Tech

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21716142

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