Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease.
Neurosurg Focus
; 49(3): E2, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32871567
ABSTRACT
OBJECTIVE:
In this study the authors compared the anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) techniques in a homogeneous group of patients affected by single-level L5-S1 degenerative disc disease (DDD) and postdiscectomy syndrome (PDS). The purpose of the study was to analyze perioperative, functional, and radiological data between the two techniques.METHODS:
A retrospective analysis of patient data was performed between 2015 and 2018. Patients were clustered into two homogeneous groups (group 1 = ALIF, group 2 = TLIF) according to surgical procedure. A statistical analysis of clinical perioperative and radiological findings was performed to compare the two groups. A senior musculoskeletal radiologist retrospectively revised all radiological images.RESULTS:
Seventy-two patients were comparable in terms of demographic features and surgical diagnosis and included in the study, involving 32 (44.4%) male and 40 (55.6%) female patients with an average age of 47.7 years. The mean follow-up duration was 49.7 months. Thirty-six patients (50%) were clustered in group 1, including 31 (86%) with DDD and 5 (14%) with PDS. Thirty-six patients (50%) were clustered in group 2, including 28 (78%) with DDD and 8 (22%) with PDS. A significant reduction in surgical time (107.4 vs 181.1 minutes) and blood loss (188.9 vs 387.1 ml) in group 1 (p < 0.0001) was observed. No significant differences in complications and reoperation rates between the two groups (p = 0.561) was observed. A significant improvement in functional outcome was observed in both groups (p < 0.001), but no significant difference between the two groups was found at the last follow-up. In group 1, a faster median time of return to work (2.4 vs 3.2 months) was recorded. A significant improvement in L5-S1 postoperative lordosis restoration was registered in the ALIF group (9.0 vs 5.0, p = 0.023).CONCLUSIONS:
According to these results, interbody fusion is effective in the surgical management of discogenic pain. Even if clinical benefits were achieved earlier in the ALIF group (better scores and faster return to work), both procedures improved functional outcomes at last follow-up. The ALIF group showed significant reduction of blood loss, shorter surgical time, and better segmental lordosis restoration when compared to the TLIF group. No significant differences in postoperative complications were observed between the groups. Based on these results, the ALIF technique enhances radiological outcome improvement in spinopelvic parameters when compared to TLIF in the management of adult patients with L5-S1 DDD.Palavras-chave
ADD = adjacent disc disease; ALIF = anterior lumbar interbody fusion; ALL = anterior longitudinal ligament; DDD = degenerative disc disease; IQR = interquartile range; LL = lumbar lordosis; LLL = lower LL; ODI = Oswestry Disability Index; PDS = postdiscectomy syndrome; PI = pelvic incidence; PT = pelvic tilt; SS = sacral slope; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; anterior lumbar interbody fusion; degenerative disc disease; functional outcome; lumbar lordosis; radiological outcome; transforaminal lumbar interbody fusion
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fusão Vertebral
/
Degeneração do Disco Intervertebral
/
Vértebras Lombares
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Neurosurg Focus
Assunto da revista:
NEUROCIRURGIA
Ano de publicação:
2020
Tipo de documento:
Article