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Sun D, Liang W, Hai Y, Yin P, Han B, Yang J. OLIF versus ALIF: Which is the better surgical approach for degenerative lumbar disease? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:689-699. [PMID: 36587140 DOI: 10.1007/s00586-022-07516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/06/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical and radiographical outcomes between OLIF and ALIF in treating lumbar degenerative diseases. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies. Changes in disc height (DH), segmental lordosis angle (SLA), lumbar lordosis (LL), visual analogue scale (VAS) score, and Oswestry disability index (ODI) between baseline and final follow-up, along with other important surgical outcomes, were assessed and analysed. Data on the global fusion rate and main complications were collected and compared. RESULTS Approximately, 2041 patients from 36 studies were included, consisting of 1057 patients who underwent OLIF and 984 patients who underwent ALIF. The results reveal no significant difference in DH, SLA, VAS score, and ODI between the two groups (all P > 0.05). The operation time, estimated blood loss, and length of hospital stay were also comparable between the two groups. Over 90% of the fusion rate was achieved in both groups. The OLIF group showed a higher complication rate than the ALIF group (OLIF 18.83% vs ALIF 7.32%). CONCLUSIONS OLIF leads to a higher complication rate, with the most notable complication being cage subsidence. Both OLIF and ALIF are effective treatments for degenerative lumbar diseases and have similar therapeutic effects. ALIF was expected to be more expensive for patients because of the necessity of involving vascular surgeons.
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Affiliation(s)
- Duan Sun
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Weishi Liang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Peng Yin
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Bo Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
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Nie JW, Hartman TJ, Pawlowski H, Prabhu MC, Vanjani NN, Oyetayo OO, Singh K. Impact of Ambulatory Setting for Workers' Compensation Patients Undergoing One-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion and Review of the Literature. World Neurosurg 2022; 167:e251-e267. [PMID: 35948231 DOI: 10.1016/j.wneu.2022.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To compare perioperative characteristics and patient-reported outcome measures (PROMs) in workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in either the inpatient/outpatient setting. METHODS Patients with WC undergoing 1-level MIS-TLIF were included. Patients were separated into inpatient/outpatient groups and demographically propensity score matched. PROMs included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI)/12-item Short Form Physical Composite Score (SF-12 PCS)/Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) preoperatively and 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results were compared preoperatively and postoperatively and between cohorts. Minimum clinically important difference (MCID) achievement was determined through comparison with values established in the literature. RESULTS A total of 216 patients were included (184 inpatient). The inpatient cohort (IC) showed worse perioperative outcomes in multiple measures (P < 0.034; all). The IC improved in all PROMs (P < 0.038; all), besides ODI at 6 weeks, SF-12 PCS at 6 weeks/6 months/1 year, and PROMIS-PF at 6 weeks. The outpatient cohort (OC) improved in VAS back at all time points and VAS leg at 6 months (P < 0.033; all). Between cohorts, the OC showed better scores with VAS leg/ODI/SF-12 PCS/PROMIS-PF at multiple time points (P < 0.031; all). Most of the IC achieved MCID, aside from ODI, whereas the OC achieved MCID in SF-12 PCS. MCID achievement between cohorts was higher in the IC at PROMIS-PF at 1 year and VAS back overall (P < 0.034; all). CONCLUSIONS Despite more comorbidities and worse perioperative measures, the IC showed improved PROMs from preoperative to ≥1 follow-up visit, whereas the OC had improvement with only VAS back and leg. The IC showed multiple MCID achievements, whereas the OC showed MCID in only SF-12 PCS. These findings may help guide a surgeon's decision making between inpatient/outpatient lumbar surgery in the WC population.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Cha EDK, Lynch CP, Jacob KC, Patel MR, Parrish JM, Jenkins NW, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Workers' Compensation Association With Clinical Outcomes After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2022; 90:322-328. [PMID: 35006206 DOI: 10.1227/neu.0000000000001820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research has suggested that workers' compensation (WC) status can result in poor outcomes after anterior cervical diskectomy and fusion (ACDF). OBJECTIVE To determine the influence WC status has on postoperative clinical outcomes after ACDF. METHODS A surgical database was reviewed for patients undergoing primary or revision single-level ACDF. Patients were grouped into WC vs Non-WC, and differences in baseline characteristics were assessed. Postoperative improvement was assessed for differences in mean scores between WC subgroups for visual analog scale (VAS) arm, VAS neck, 12-item Short Form Physical Composite Score, Patient-Reported Outcomes Measurement Information System physical function (PF), and Neck Disability Index (NDI) at preoperative and postoperative time points. Minimum clinically important difference (MCID) achievement was compared between groups. RESULTS The patient cohort included 44 with WC and 95 without. The cohort was 40% female with an average age of 48 years and mean body mass index of 30. Mean VAS arm, VAS neck, NDI, 12-item Short-Form Physical Composite Score, and Patient-Reported Outcomes Measurement Information System PF scores differed between groups; however, the difference was not sustained at the 1-yr time point. MCID achievement among WC subgroups was different for VAS arm (6 wk through 6 mo, P = .005), VAS neck (3 and 6 mo, P < .01), and NDI (3 and 6 mo, P < .05). No statistically significant difference was noted between cohorts for overall rates of MCID achievement for all patient-reported outcome measures collected. CONCLUSION WC patients reported similar preoperative and 1-yr postoperative neck and arm pain compared with non-WC patients after ACDF. One-yr MCID achievement rates were similar between cohorts for disability and PF scores.
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Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Achttien RJ, Powell A, Zoulas K, Staal JB, Rushton A. Prognostic factors for outcome following lumbar spine fusion surgery: a systematic review and narrative synthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:623-668. [PMID: 34705106 DOI: 10.1007/s00586-021-07018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to identify and evaluate the value of prognostic factors related to disability, pain and quality of life (QoL) for adult patients undergoing lumbar spine fusion surgery (LSFS). METHODS Two reviewers independently searched the literature, assessed eligibility, extracted data and assessed risk of bias and certainty of evidence. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. LSFS] to 20/9/2020; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥ 12-month follow-up after LSFS were included. Narrative synthesis was based on recommendations by Cochrane Consumers and Communication Review Group. The GRADE tool enabled assessment of certainty of evidence. Prognostic factors and outcome were analysed and summarised when examined in ≥ 2 studies and when results pointed in the same direction in ≥ 75% of studies. RESULTS Sixteen studies (n = 8388, 2 low and 14 high risk of bias) were included with 39 prognostic factors identified. There is low certainty evidence that higher pre-operative severity of leg pain predicts greater improvement of leg pain and that pre-operative working predicts less post-operative disability both at 1-2-year follow-up. Other found associations were of very low certainty evidence. CONCLUSION No moderate to high certainty evidence exists. Use of leg pain and pre-operative working may be valuable predictors of outcome to inform clinical decision-making and advice regarding LSFS surgery. There is need for adequately powered low-risk-of-bias prospective observational studies to further investigate candidate prognostic factors.
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Affiliation(s)
- Retze J Achttien
- HAN University of Applied Science, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands.
| | - Andrew Powell
- British Canoeing, Lee Valley Whitewater Centre, English Institute of Sport, Station Road, Waltham Cross, Hertfordshire, UK
| | | | - J Bart Staal
- HAN University of Applied Science, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Alison Rushton
- School of Physical, Therapy Western University, London, Ontario, Canada
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Does Workers' Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116165. [PMID: 34200483 PMCID: PMC8201180 DOI: 10.3390/ijerph18116165] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022]
Abstract
Low back pain (LBP) is currently the leading cause of disability worldwide and the most common reason for workers’ compensation (WC) claims. Studies have demonstrated that receiving WC is associated with a negative prognosis following treatment for a vast range of health conditions. However, the impact of WC on outcomes after spine surgery is still controversial. The aim of this meta-analysis was to systematically review the literature and analyze the impact of compensation status on outcomes after lumbar spine surgery. A systematic search was performed on Medline, Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patients undergoing lumbar spine surgery in which compensation status was reported. Methodological quality was assessed through ROBINS-I and quality of evidence was estimated using the GRADE rating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patients had higher post-operative pain and disability, as well as lower satisfaction after surgery when compared to those without WC. Furthermore, WC patients demonstrated to have a delayed return to work. According to our results, compensation status is associated with poor outcomes after lumbar spine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helps understand the multifactorial nature of the phenomenon.
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Budiono GR, McCaffrey MH, Parr WCH, Choy WJ, Singh T, Pelletier MH, Mobbs RJ. Development of a Multivariate Prediction Model for Successful Oswestry Disability Index Changes in L5/S1 Anterior Lumbar Interbody Fusion for Degenerative Disc Disease. World Neurosurg 2020; 148:e1-e9. [PMID: 33189919 DOI: 10.1016/j.wneu.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD. METHODS A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed. RESULTS After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001-0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05-1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44-1.09 and OR, 0.97, 95% CI, 0.81-1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line. CONCLUSIONS This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD.
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Affiliation(s)
- Gideon R Budiono
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
| | - Miles H McCaffrey
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - William C H Parr
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia; 3DMorphic Pty Ltd., Sydney, New South Wales, Australia
| | - Wen J Choy
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Telvinderjit Singh
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Matthew H Pelletier
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
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7
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Manzur M, Virk SS, Jivanelli B, Vaishnav AS, McAnany SJ, Albert TJ, Iyer S, Gang CH, Qureshi S. The rate of fusion for stand-alone anterior lumbar interbody fusion: a systematic review. Spine J 2019; 19:1294-1301. [PMID: 30872148 DOI: 10.1016/j.spinee.2019.03.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) has been used for treatment of a variety of spinal conditions including degenerative disc disorders and low-grade spondylolisthesis. Expected fusion rate of stand-alone ALIF constructs is currently unclear. The aim of this study was to examine the fusion rate for ALIF without supplemental posterior fusion or instrumentation (stand-alone ALIF). METHODS We queried the MEDLINE, COCHRANE, and EMBASE databases for all literature related to spine fusion rates using a stand-alone ALIF procedure with a publication cutoff date of July 19, 2018. Supplementary combinations of search terms included spine, fusion, fixation, rate(s), and arthrodesis. ALIF surgery was considered stand-alone when not paired with supplemental posterior fusion or posterior spinal instrumentation. Nonhuman and non-English publications were excluded. Cohort fusion rate differences were calculated using Student t test with significance assigned if p value was less than .05. RESULTS Title and abstract level review required assessing 840 unique publications. Across the 55 studies that met the inclusion criteria of this systematic review, 5,517 patients and 6,303 vertebral levels were fused. The overall weighted average patient fusion rate following stand-alone ALIF was 88.2% (range: 16.6%-100%). In the 31 studies with at least 50 subjects, the weighted average fusion rate following stand-alone ALIF was 88.6% (range: 57.5%-99.0%). Use of anterior fixation plate devices yielded a fusion rate of 94.2%. Newer zero-profile interbody implants had a fusion rate of 89.2%. Fusion rates were lower in studies with 50% or more subjects having positive smoking and worker's compensation status, however these results were found to be statistically insignificant (p>.05). Fusion rate for subjects in the eight rhBMP-2 study groups was 94.4% (n=889) compared with 84.8% (n=3,102) in 38 study groups without rhBMP-2 used. CONCLUSIONS Based on the available data, stand-alone ALIF procedures yield high fusion rates overall. Fusion failure and pseudoarthrosis rates are higher in study populations involving a high percentage of smokers or positive workers compensation status. Allograft utilization does not significantly improve fusion rate when compared with autograft in stand-alone ALIF constructs.
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Affiliation(s)
- Mustfa Manzur
- Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA
| | - Sohrab S Virk
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Bridget Jivanelli
- The Kim Barrett Memorial Library, Hospital for Special Surgery, New York, NY 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Steven J McAnany
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Todd J Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | | | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA.
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Phan K, Fadhil M, Chang N, Giang G, Gragnaniello C, Mobbs RJ. Effect of Smoking Status on Successful Arthrodesis, Clinical Outcome, and Complications After Anterior Lumbar Interbody Fusion (ALIF). World Neurosurg 2018; 110:e998-e1003. [DOI: 10.1016/j.wneu.2017.11.157] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022]
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9
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Phan K, Lackey A, Chang N, Ho YT, Abi-Hanna D, Kerferd J, Maharaj MM, Parker RM, Malham GM, Mobbs RJ. Anterior lumbar interbody fusion (ALIF) as an option for recurrent disc herniations: a systematic review and meta-analysis. JOURNAL OF SPINE SURGERY 2017; 3:587-595. [PMID: 29354736 DOI: 10.21037/jss.2017.11.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Recurrent intervertebral disc herniation is a relatively common occurrence after primary discectomy for lumbar intervertebral disc herniation. For recurrent herniations after repeat discectomies, a growing body of evidence suggests that fusion is effective in appropriately selected cases. Theoretically, anterior lumbar interbody fusion (ALIF) allows for comprehensive discectomy, less trauma to spinal nerves and paraspinal muscles and avoidance of the disadvantages of repeat posterior approaches. However, ALIF has also been associated with risk of vascular injury and retrograde ejaculation. This current systematic review and meta-analysis aims to assess the viability of ALIF as a surgical treatment for recurrent disc herniations. Methods Seven studies were identified from six electronic databases and secondary reference lists. Pre-defined endpoints were extracted from the included studies and meta-analyzed. Results For the 181 patients from included studies, ALIF resulted in significant average improvements in Oswestry Disability Index (ODI) scores (50.49%, P<0.001), Visual Analogue Scale (VAS) back pain scores (47.85%, P<0.001) and VAS leg pain scores (37.00%, P<0.001). Average blood loss was acceptable at 122 mL (P<0.001) and average operation duration was 89 minutes (P<0.001). Average hospital stay was 5.28 days (P<0.001). Only 22 perioperative complications were reported, with subsidence the most commonly reported complication. Conclusions Pooled evidence suggests that ALIF is a feasible approach for the treatment of recurrent disc herniations, demonstrating significant improvements in back and leg pain and minimal complications. These findings warrant further investigation in large prospective registries and multi-center studies.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Alan Lackey
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - Nicholas Chang
- Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Yam-Ting Ho
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - David Abi-Hanna
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Monish M Maharaj
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | | | | | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
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10
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Mobbs RJ, Lennox A, Ho YT, Phan K, Choy WJ. L5/S1 anterior lumbar interbody fusion technique. JOURNAL OF SPINE SURGERY 2017; 3:429-432. [PMID: 29057354 DOI: 10.21037/jss.2017.09.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Public Hospital, Randwick, Sydney, Australia
| | - Andrew Lennox
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Yam-Ting Ho
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Public Hospital, Randwick, Sydney, Australia
| | - Wen Jie Choy
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
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11
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Giang G, Mobbs R, Phan S, Tran TM, Phan K. Evaluating Outcomes of Stand-Alone Anterior Lumbar Interbody Fusion: A Systematic Review. World Neurosurg 2017; 104:259-271. [PMID: 28502688 DOI: 10.1016/j.wneu.2017.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Stand-alone anterior lumbar interbody fusion (ALIF) is an effective surgical approach for selected spinal pathologies. It avoids the morbidity and complications associated with instrumented ALIF, such as plate fixation and the traditionally used posterior approach. Despite improved disc space visualization and clearance, the associated posterior instability and increased risk of nonfusion present major challenges to this approach. The integral cage design aims to address these challenges by providing the necessary stabilization through intracorporeal screws. However, there is limited and controversial data available for stand-alone ALIF and integral cage fixation. To our knowledge, this is the first systematic review to evaluate recent findings on outcomes of stand-alone ALIF devices to explore areas of controversy and identify directions for future research. METHODS Two reviewers conducted independent, systematic literature searches for appropriate studies in 5 electronic databases as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were filtered by the use of specified selection criteria, particularly exclusion of studies with supplementary fixation to ALIF and studies published before the year 2000. A total of 17 studies met the criteria, and their data were comprehensively extracted and analyzed. RESULTS The current literature is supportive of stand-alone ALIF due to acceptable clinical outcomes, promising fusion rates and disc height restoration. However, data and outcomes remain preliminary, and there are numerous areas of controversy. CONCLUSIONS There is evidence for the efficacy and safety of stand-alone ALIF. However, the extent of improvement based on specific indications for surgery remains unclear. Further investigation utilizing more methodologically rigorous studies of long-term outcomes is necessary to address these issues.
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Affiliation(s)
- Gloria Giang
- Faculty of Medicine, University of New South Wales, New South Wales, Australia; NeuroSpine Surgery Research Group, Neuro Spine Clinic, Prince of Wales Private Hospital, New South Wales, Australia
| | - Ralph Mobbs
- Faculty of Medicine, University of New South Wales, New South Wales, Australia; NeuroSpine Surgery Research Group, Neuro Spine Clinic, Prince of Wales Private Hospital, New South Wales, Australia; Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Steven Phan
- NeuroSpine Surgery Research Group, Neuro Spine Clinic, Prince of Wales Private Hospital, New South Wales, Australia
| | - Tommy Manh Tran
- NeuroSpine Surgery Research Group, Neuro Spine Clinic, Prince of Wales Private Hospital, New South Wales, Australia
| | - Kevin Phan
- Faculty of Medicine, University of New South Wales, New South Wales, Australia; NeuroSpine Surgery Research Group, Neuro Spine Clinic, Prince of Wales Private Hospital, New South Wales, Australia; Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
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