Article Figures & Data
Figures
- Figure 1
Fluoroscopic images of anterior lumbar interbody fusion. (A) Anterior L5/S1 disc exposure. (B) Seven-millimeter paddle distractor (not rotated) to posterior apophyseal ring. (C) Nine-millimeter paddle distractor (rotated) to posterior apophyseal ring. (D) Large 13 mm, 15° trial. (E) Large 15 mm, 15° trial. (F) Large 15 mm, 15° cage. (G) Cage with screw fixation (lateral). (H) Cage with screw fixation (anteroposterior).
- Figure 2
Example fusion on 12-month postoperative computed tomography for standalone anterior lumbar interbody fusion (ALIF) (A) sagittal and (B) coronal view and for ALIF with pedicle screw fixation (C) sagittal and (D) coronal view.
Tables
Grade Percent Slippage Grade 1 0%–25% Grade 2 25%–50% Grade 3 50%–75% Grade 4 75%–100% Grade 5 >100% (spondyloptosis) Characteristic sa-ALIF and ALIF + PSF (n = 51) sa-ALIF (n = 22) ALIF + PSF (n = 29) P Men, n (%) 30 (58.8) 12 (54.5) 18 (62.1) NS Age (mean ± SD) 46.4 ± 12.8 43.3 ± 14.1 48.7 ± 11.4 NS Follow-up in years (mean ± SD) 3.9 ± 3.2 2.1 ± 1.8 5.3 ± 3.4 0.004 BMI kg/m2 (mean ± SD) 26.6 ± 4.1 24.1 ± 2.6 27.9 ± 4.2 0.02 Smoking status (n, %) Yes 4 (7.8) 1 (4.5) 3 (10.3) NS Ex 11 (21.6) 1 (4.5) 10 (34.5) 0.0100 No 36 (70.6) 20 (91.0 16 (55.2) 0.0055 Insurance status Private 50 21 29 NS Worker’s compensation 1 1 0 Grade I 43 22 21 0.0073 II 8 0 8 Operation Single level 47 20 27 NS L4/5 TDR and L5/S1 ALIF 2 1 1 L4/5 ALIF and L5/S1 ALIF 2 1 1 Cage type Cage + buttress plate 6 1 5 NS Integrated cage 45 21 24 Bone substitute rhBMP-2 31 (60.8) 5 (22.7) 26 (89.7) <0.0001 DBA 20 (39.2) 17 (77.3) 3 (10.3) <0.0001 Abbreviations: ALIF, anterior lumbar interbody fusion; BMI, body mass index; DBA, demineralized bone allograft; NS, not significant; PSF, pedicle-screw fixation; rhBMP-2, recombinant human bone morphogenic protein 2; sa-ALIF, standalone anterior lumbar interbody fusion; TDR, total disc replacement.
Cohort PROMs at 0 mo PROMs at 6 wk sa-ALIF ALIF-PSF P sa-ALIF ALIF-PSF P VAS leg 7.2 ± 1.7 8.1 ± 1.5 0.035 2.7 ± 2.2 4.9 ± 1.7 0.0002 VAS back 7.5 ± 1.4 7.2 ± 1.9 NS 4.1 ± 1.4 4.1 ± 2.0 NS ODI 28.0 ± 5.3 30.9 ± 4.8 NS 18.6 ± 6.2 21.1 ± 5.0 NS SF-12 PCS 27.9 ± 5.7 26.3 ± 4.1 NS 39.9 ± 6.3 36.8 ± 4.4 0.042 SF-12 MCS 51.2 ± 8.9 51.7 ± 6.2 NS 55.2 ± 5.9 54.4 ± 4.3 NS Cohort PROMs at 6 mo PROMs at 12 mo sa-ALIF ALIF-PSF P sa-ALIF ALIF-PSF P VAS leg 1.7 ± 1.7 2.3 ± 2.0 NS 0.8 ± 1.0 1.8 ± 1.7 NS VAS back 2.7 ± 1.5 2.4 ± 1.8 NS 2.3 ± 1.7 1.8 ± 2.0 NS ODI 11.9 ± 5.6 9.5 ± 5.5 NS 8.7 ± 7.0 7.7 ± 6.0 NS SF-12 PCS 45.9 ± 5.3 48.5 ± 7.1 NS 50.5 ± 6.2 50.4 ± 6.8 NS SF-12 MCS 54.9 ± 5.7 53.8 ± 4.6 NS 53.4 ± 4.2 54.4 ± 4.1 NS Cohort PROMs at Final Follow-Up sa-ALIF (mean follow-up = 2.1 y) ALIF-PSF (mean follow-up = 5.3 y) P VAS leg 0.9 ± 1.1 1.4 ± 1.5 NS VAS back 2.4 ± 1.4 2.3 ± 2.0 NS ODI 5.6 ± 3.7 6.9 ± 5.0 NS SF-12 PCS 52.1 ± 4.4 48.4 ± 6.6 NS SF-12 MCS 52.6 ± 3.3 52.6 ± 3.9 NS Decision regret score 5.8 ± 10.4 2.5 ± 11.2 NS Abbreviations: ALIF, anterior lumbar interbody fusion; MCS, mental component summary; NS, not significant; ODI, Oswestry Disability Index; PCS, physical component summary; PROMs, patient-reported outcome measures; PSF, pedicle-screw fixation; sa-ALIF, standalone anterior lumbar interbody fusion; SF-12, 12-item Short-Form survey; VAS, visual analog scale.
Cohort Fusion at 6 mo Fusion at 12 mo sa-ALIF ALIF-PSF P sa-ALIF ALIF-PSF P Mean ± SD 2.5 ± 0.6 2.6 ± 0.6 0.76 2.1 ± 0.5 2.0 ± 0.6 0.75 Bridwell grade, n (%) n = 22 n = 26 n = 22 n = 26 I 1 (4.5) 0 2 (9.1) 3 (11.5) II 7 (31.8) 13 (50.0) 16 (72.7) 20 (76.9) III 14 (63.6) 12 (46.2) 4 (18.2) 2 (7.7) IV 0 1 (3.8) 0 1 (3.8) Fused (Bridwell I/II) 8 (36.4) 13 (50.0) 0.34 18 (81.8) 23 (88.5) 0.52 Abbreviations: ALIF, anterior lumbar interbody fusion; PSF, pedicle-screw fixation; sa-ALIF, standalone anterior lumbar interbody fusion.
Cohort Preoperative 6 mo Postoperative 12 mo Postoperative sa-ALIF (n = 6) ALIF-PSF (n = 11) P sa-ALIF (n = 17) ALIF-PSF (n = 22) P sa-ALIF (n = 12) ALIF-PSF (n = 14) P % anterolisthesis 15.4 ± 7.7 17.5 ± 8.3 NS 11.9 ± 6.6 14.6 ± 8.8 NS 13.1 ± 2.2 13.5 ± 2.7 NS Segmental lordosis, mm 11.7 ± 5.9 10.0 ± 5.9 NS 14.7 ± 1.2 12.9 ± 1.2 NS 13.4 ± 1.1 12.3 ± 1.4 NS Disc height, mm 7.1 ± 2.6 6.9 ± 2.1 NS 12.1 ± 0.3 10.4 ± 0.6 0.035 11.8 ± 0.4 10.7 ± 0.5 NS Abbreviations: ALIF, anterior lumbar interbody fusion; NS, not significant; PSF, pedicle-screw fixation; sa-ALIF, standalone anterior lumbar interbody fusion.
Adverse Events Total (N = 51) sa-ALIF (n = 22) ALIF + PSF (n = 29) Total complications 12 2 10 Acute complications Superficial wound infection 3 0 3 Chronic complications Persisting mechanical back pain (VAS back >5) 4 1 3 Persisting radicular lower extremity pain (VAS leg >5) 4 1 3 Reoperation PSF revision requiring posterior decompression 1 0 1 Abbreviations: ALIF, anterior lumbar interbody fusion; PSF, pedicle-screw fixation; sa-ALIF, standalone anterior lumbar interbody fusion; VAS, visual analog scale.
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