Comparison of Stand-Alone Anterior Lumbar Interbody Fusion, 360° Anterior Lumbar Interbody Fusion, and Arthroplasty for Recurrent Lumbar Disc Herniation: Focus on Nerve Decompression and Painful Spinal Instability Resolution

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1
Strengthening the Reporting of Observational Studies in Epidemiology study flowchart.
Download figure
Open in new tab
Download powerpoint
Figure 2
Stand-alone anterior lumbar interbody fusion: (A) Preoperative image. (B and C) Postoperative images.
Download figure
Open in new tab
Download powerpoint
Figure 3
360° anterior lumbar interbody fusion: (A) Preoperative magnetic resonance imaging. (B) Preoperative x-ray image. The red circle indicates segmental instability due to listhesis. (C and D) Postoperative x-ray images.
Download figure
Open in new tab
Download powerpoint
Figure 4
Arthroplasty: (A) Preoperative image. (B and C) Postoperative images.

Table 1

Characteristics of patients (N = 65) undergoing stand-alone ALIF, 360° ALIF, or arthroplasty for recurrent lumbar disc herniation.

Abbreviations: ALIF, anterior lumbar interbody fusion; BMI, body mass index.
↵a There was no significant difference between stand-alone ALIF vs arthroplasty (P = 0.142) and ALIF Stand-Alone vs 360° ALIF (P = 0.0685). There was a significant difference between the arthroplasty group vs ALIF 360° (P = 0.0007).

Table 2

Perioperative details of patients (N = 65) undergoing stand-alone ALIF, 360° ALIF, or arthroplasty for recurrent lumbar disc herniation.

Table 3

Outcomes of patients (N = 65) undergoing stand-alone ALIF, 360° ALIF, or arthroplasty for recurrent lumbar disc herniation.

Characteristic	Stand-Alone ALIF	360° ALIF	Arthroplasty	P	Total
Intraoperative injury, n (%)
Arterial injury	0	0	0	-	0
Venous injury	0	0	0	-	0
Peritoneal structures injury	0	0	0	-	0
Nerve root involvement	0	0	0	-	0
Dural sac injury	0	0	0	-	0
Operative time, min, mean (SD)	165.8 (61.72)	236.25 (46.30)	98.43 (45)	< 0.0001^{^a}	175.23 (74.69)
1 level	164.61 (65.29)	238 (50.73)	96 (45.48)	< 0.0001^{^a}	166.27 (80.35)
2 levels	172.50 (62.37)	246.42 (25.28)	-^{^b}	0.02^{^c}	188.82 (58.98)
3 levels	190 (14.14)	257.5 (88.38)	-^{^d}	< 0.0001^{^c}	223.75 (64.72)
Length of hospital stay, d, mean (SD)	2.2 (0.76)	2.75 (1.48)	2.43 (1.03)	0.515	2.46 (1.14)
1 level	1.93 (0.76)	2.8 (1.65)	2.33 (0.97)	0.172	2.37 (1.24)
2 levels	2.5 (0.7)	3 (1.15)	-^{^b}	0.334^{^e}	2.7 (0.92)
3 levels	2.7 (0.71)	3.2 (0.62)	-^{^d}	0.293^{^e}	2.95 (0.65)
Postoperative complications, n (%)
Cavitary hematoma	0	0	0	-	0
Wall hematoma	0	0	0	-	0
Surgical wound infection	1 (4%)	0	0	0.444	1 (1.54%)
Retroperitoneal infection	0	0	0	-	0
Lymphocele	0	0	0	-	0
Evisceration/eventration	0	0	0	-	0
DVT	0	0	0	-	0
Retrograde ejaculatio	0	0	0	-	0
Sympathetic changes	1 (4%)	1 (0.41%)	2 (12.5%)	0.477	4 (6.16%)

Abbreviations: ALIF, anterior lumbar interbody fusion; DVT, deep vein thrombosis.
↵a All subgroups showed significant differences (all P < 0.0001 in post-hoc analysis).
↵b One patient had 2 operated levels in the arthroplasty group. The operative time for this patient was 134 minutes. The hospitalization duration was 4 days.
↵c The P values were calculated using the Student t test comparing the 360° ALIF and stand-alone ALIF groups. In both cases, there was a statistically significant difference.
↵d There were no patients with 3 operated levels in the arthroplasty group.
↵e P values were calculated using the Student t test comparing the ALIF 360° and ALIF stand-alone groups. In both cases, there was no statistically significant difference.