Anterolateral lumbar interbody fusion vs transforaminal lumbar interbody fusion in L4/5 degree Ⅰ degenerative spondylolisthesis

English Keywords:Degenerative spondylolisthesis  Anterolateral lumbar interbody fusion  Transforaminal lumbar interbody fusion  Efficacy

English Abstract:

  【Abstract】 Objectives: To compare the efficacy of anterolateral lumbar interbody fusion(ALLIF) and transforaminal lumbar interbody fusion(TLIF) in L4/5 degree Ⅰ degenerative spondylolisthesis. Methods: Six-eight patients with L4/5 degree Ⅰ degenerative spondylolisthesis who underwent surgical treatment from April 2013 to April 2015 were reviewed, including 32 patients(20 males and 12 females) undergoing ALLIF with age of 51.5±11.9(range, 40-65 years old) and 36 patients(22 males and 14 females) undergoing TLIF with age of 50.3±8.6(range, 42-63 years old). The following were recorded: demographic details, perioperative complications, visual analog scale(VAS) scores of leg and back, the Oswestry disability index(ODI) scores. Radiographic outcomes before surgery, at 1 week, 6 months, 12 months and 24 months after surgery were measured: fusion rate, cage subsidence, lumbar lordosis(LL), disc height(DH), segmental lordotic angle(SLA) and the percentage of slip(SLIP%). Results: There were no statistical differences in age, sex ratio, body mass index(BMI), preoperative VAS scores of low back and leg, radiographic outcomes and follow-up time between the two groups(P>0.05). The mean operation time and blood loss in group ALLIF were significantly less than those in group TLIF(106.42±8.47ml vs. 249.48±30.16ml, P＜0.05; 69.98±11.06min vs 133.4±23.7min, P＜0.05). There was no vessel injury, dural tear, neurological deficit, peritoneal tear, abdominal organ injury, incision hernia, implant loosening or fracture, or other complication in both groups. The postoperative VAS back pain, VAS leg pain and ODI at each follow-up time point were significantly improved(P<0.05) in both groups. The VAS back pain, VAS leg pain and ODI score at each follow-up time point between the two groups were not statistically different(P>0.05). The postoperative DH, LL, ILA and Slip% in both groups were significantly improved when compared to the preoperative data(P<0.05). The Slip% between the two groups at each follow-up time point was not significantly different(P>0.05). The postoperative DH, LL, SLA in group ALLIF were better than those in group TLIF at each follow-up time point(P<0.05). Bony fusion was achieved in all the patients of two groups at the final follow-up. There were 5 cases(15.6%) of subsidence without symptom in group ALLIF. Conclusions: ALLIF and TLIF can achieve satisfactory clinical efficacy in L4/5 degree Ⅰ degenerative spondylolisthesis. ALLIF has less blood loss and shorter operation time than TLIF surgery, and it can better restore the height of intervertebral space and lumbar lordosis. ALLIF can be an alternative treatment of degenerative spondylolisthesis in strictly selected cases.