Abstract
Introduction
Lumbar fusion is a mainstay in the treatment of low back pain resulting from degenerative disc disease. Of the various fusion techniques available, anterior lumbar interbody fusion (ALIF) has become a good treatment technique to achieve this goal. Our aims were to describe our experience with lumbosacral ALIF performed in cooperation of neurosurgeons and vascular surgeons and analysis of improvement in function and a biometrical aspects.
Material and Methods
From 2011–14, 33 patients underwent ALIF, 45 were identified as having a single level procedure at L5-S1 from a mini-open retroperitoneal approach. The cases were reviewed to determine fusion status, incidence of complications and length of stay. Disc space heights were determined using a ratio of disc space height to superior end plate length. For each treatment group, anterior and posterior disc space measurements were collected on a lateral radiograph and averaged to obtain a measure for disc space height. Statistical analysis was performed using Statistica 8.0.
Results
The average length of hospitalization was 4 days. Most of patients had spinal cord stenosis. 3 patients had early complications like parestesis of lower limbs, but there were no major complications. Blood loss was less than 75 cc in all cases. The SynFix-LR implants were used for all - average size 12,31 mm and angle 11,61. The pre-op angle of lordosis was 12,3° and post-op +8,9° added. The average disc space before treatment was 10 mm and after +7,17mm added.
Conclusion
The mini-open ALIF approach for L5-S1 fusion is a reasonable alternative to the more extensive posterior approaches. Although no direct comparison with the more extensive approach has been performed, our initial experience suggests that this procedure may reduce pain, blood loss, complications and length of hospital stay. ALIF significantly restores the height of the intervertebral disc and provides stability. Based on these results, it would appear that in properly selected patients ALIF with neurosurgeon-vascular surgeon cooperation raises the standard of comparison for nonfusion methodologies with regards to short and long-term pain relief and functional recovery.