Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 – What Is the Best Way to Restore a physiological Alignment?

Abstract

Study Design A retrospective single center cohort study with prospective collected data from an institutional spine registry.

Objectives To determine whether restoration of lordosis L5/S1 is possible with both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) and to find out which technique is superior to recreate lordosis in L5/S1.

Methods Seventy-seven patients with ALIF and seventy-nine with TLIF L5/S1 were included. Operation time, estimated blood loss), and complications were evaluated. Segmental lordosis L5/S1 and L4/5, overall lordosis, and proximal lordosis (L1 to L4) were measured in X-rays before and after surgery. Oswesery disability index and EQ-5D were assessed before surgery, and 3 and 12 months after surgery.

Results Mean operation time was 176.9 minutes for ALIF and 195.7 minutes for TLIF (p = 0.048). Estimated blood loss was 249.2 cc for ALIF and 362.9 cc for TLIF (p = 0.005). In terms of complications, only a difference in dural tears were found (TLIF 6, ALIF none; p = 0.014). Lordosis L5/S1 increased in the ALIF group (15.8 to 24.6°; p < 0.001), whereas no difference was noted in the TLIF group (18.4 to 19.4°; p = 0.360). Clinical results showed significant improvement in the Oswesery disability index (ALIF: 43 to 21.9, TLIF: 45.2 to 23.0) and EQ-5D (ALIF: 0.494 to 0.732, TLIF: 0.393 to 0.764) after 12 months in both groups, without differences between the groups.

Conclusion ALIF and TLIF are comparable methods for performing fusion at L5/S1, with good clinical outcomes and comparable rates of complications. However, there is only a limited potential for recreating lordosis at L5/S1 with a TLIF.

Zusammenfassung

Studiendesign Eine retrospektive Single-Center-Kohortenstudie mit prospektiv erhobenen Daten eines institutionellen Wirbelsäulenregisters.

Ziele Es wurde untersucht, ob eine Wiederherstellung der Lordose L5/S1 sowohl mit ALIF als auch mit TLIF möglich ist und welche Technik zur Wiederherstellung der Lordose bei L5/S1 überlegen ist.

Methoden 77 Patienten mit ALIF und 79 mit TLIF L5/S1 wurden eingeschlossen. Operationszeit (OT), geschätzter Blutverlust (EBL) und Komplikationen wurden ausgewertet. Die segmentale Lordose L5/S1 und L4/5, die Gesamtlordose (LL) und die proximale Lordose (L1 bis L4) wurden in Röntgenbildern vor und nach der Operation ermittelt. Oswesery disability index (ODI) und EQ 5D wurden vor der Operation, 3 und 12 Monate nach der Operation ausgewertet.

Ergebnisse Die mittlere OT betrug 176,9 min für ALIF und 195,7 min für TLIF (p = 0,048). Die EBL betrug 249,2cc für ALIF und 362,9 cc für TLIF (p = 0,005). In Bezug auf Komplikationen wurde nur ein Unterschied bei den Duraläsionen gefunden (TLIF 6, ALIF keine, p = 0,014). Die Lordose L5/S1 nahm in der ALIF-Gruppe postoperativ zu (15,8 bis 24,6°, p < 0,001), während in der TLIF-Gruppe kein signifikanter Unterschied festgestellt wurde (18,4° bis 19,4°, p = 0,360). Die klinischen Ergebnisse zeigten eine signifikante Verbesserung des ODI (ALIF: 43 auf 21,9, TLIF: 45,2 auf 23,0) und des EQ 5D (ALIF: 0,494 auf 0,732, TLIF: 0,393 auf 0,764) nach 12 Monaten in beiden Gruppen, ohne Unterschiede zwischen den Gruppen.

Schlussfolgerung Sowohl ALIF als auch TLIF sind vergleichbare Methoden zur Durchführung einer Fusion an L5/S1, mit guten klinischen Ergebnissen und vergleichbaren Komplikationsraten. Allerdings besteht bei Durchführung eines TLIF nur ein begrenztes Potenzial zur Wiederherstellung der Lordose bei L5/S1.

Key words

lumbar lordosis - spinal fusion - sagittal alignment - lumbosacral fusion

Schlüsselwörter

lumbale Lordose - sagittales Alignment - lumbosakrale Fusion - lumbale Fusion

Publication History

Article published online:
08 September 2021

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