Stand-alone Anterior Versus Anteroposterior Lumbar Interbody Single-level Fusion After a Mean Follow-up of 41 Months

Study Design: Prospective cohort study comparing evaluations of single-level anterior lumbar interbody fusion (ALIF) versus anteroposterior lumbar fusion (APLF). Objective: To clinically and radiologically compare the outcome after angle-stable, locked, stand-alone ALIF with that obtained after APLF, in cases with degenerative disc disease (DDD). Summary of Background Data: Fusion rates have been reported to be highest after interbody fusion with transpedicular fixation. However, transpedicular fixation is linked to significant damage of the paravertebral muscles, to screw displacement-related neurological and vascular complications, and to an increased rate of adjacent segment degeneration. When performed as a stand-alone procedure, the disadvantages of transpedicular fixation can be completely avoided by ALIF. Methods: Eighty patients with chronic low-back pain due to a single-level DDD (Modic >= 2) and facet joint arthritis (Fujiwara >= 3) were enrolled in this study. Forty patients received an anteroposterior fusion (ALIF with transpedicular fixation: APLF group) and 40 patients (ALIF group) were treated with a stand-alone ALIF using the Synfix-LR device. At 7 days, 3, 6, 12, and 24 months, and at a mean follow-up of 41 months, patients were clinically (visual analog scale, Oswestry Low Back Pain Disability Index, satisfaction) and radiologically (x-ray, and at 12 months, thin-slice computed tomography) compared. Results: Blood loss and duration of surgery were significantly lower in the ALIF group (P < 0.001). Visual analog scale and Oswestry Low Back Pain Disability Index improved significantly over time (analysis of variance, P < 0.001) in both groups, but both scores were significantly better in ALIF group (analysis of variance, P < 0.001). Patients' satisfaction consistently ranked higher in the ALIF group (P = 0.042 at 12 mo). No significant difference was found in the fusion rate throughout the study. Conclusions: Stand-alone ALIF leads to better clinical results than APLF, without differences in fusion rates after 41 months. Therefore, when a posterior approach is not needed for decompression or reposition, we suggest performing a stand-alone ALIF in cases with single-level DDD.