Abstract
Introduction
This review compares the safety of the interbody fusion procedures anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders. ALIF is well established whereas ELIF is a novel procedure.
Materials and Methods
We performed a systematic literature search in the databases Cochrane (CENTRAL), MEDLINE, EMBASE, and the FDA register. Information was collected on study design, sample size, population, procedure, indication incl. number, and location of levels involved, follow-up (FU) time and adverse events. Moreover, information on conflict of interest and source of funding was captured.
Results
Of 32 eligible publications, 22 dealt with ELIF, 9 with ALIF, and 1 compared ELIF with ALIF. All of the ELIF studies were case series. The number of patients was 2,165 and 1,379, with a FU time from 45 days to 24 months and 24 months to 5 years for ELIF and ALIF, respectively. The risk to experience certain types of adverse events (e.g., reoperations, hardware failures, DVT, and cardiac) appeared significantly lower for patients undergoing ELIF. Pseudarthrosis was seen in 0.14 and 1.02% of ELIF and ALIF cases, respectively. Neurological complications occurred in 7.62% of ELIF and 9.43% of ALIF cases.
| Category of adverse event | ELIF (N = 2,165), % (95% CI) | ALIF (N = 379), % (95% CI) | Risk ratio (95% CI) | p Value |
|---|---|---|---|---|
| Neurologic AEs (transient motor weakness, transient hypoesthesia, transient thigh symptoms) | 7.62 (6.58-8.82) | 9.43 (7.992-11.09) | 0.79 (0.6234-1.009) | 0.059 |
| Pseudarthrosis | 0.14 (0.02665-0.4271) | 1.02 (0.5891-1.714) | 0.1354 (0.03106-0.4379) | 0.000 |
| Hardware failure (subsidence of cage, intraoperative pedicle fracture, implant bone interface failure, and cage breakage) | 1.39 (0.965-1.979) | 3.41 (2.564-4.511) | 0.40 (0.2484-0.6315) | 0.000 |
| Secondary surgical procedure (revisions, supplemental fixations, and reoperations) | 1.85 (1.353-2.512) | 8.77 (7.389-10.39) | 0.1958 (0.1348-0.2801) | < 0.0001 |
Conclusion
ELIF procedures demonstrated a favorable safety outcome compared with ALIF, nonetheless the lack of comparative studies, length of follow-up, and low level of evidence is a limitation of this review.
R. Hartl: Conflict with DePuy Synthes, Spine Wave, Brainlab, Lanx
F. Christensen: None declared
A. Korge: None declared
K. Lam: None declared
E. Vialle: None declared
J. Zigler: None declared
R. McGuire: None declared