Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Moira Vieli; Victor E Staartjes; Hubert A J Eversdjik; Marlies P De Wispelaere; Jan Wolter A Oosterhuis; Marc L Schröder

doi:10.7759/cureus.5332

Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Cureus. 2019 Aug 7;11(8):e5332. doi: 10.7759/cureus.5332.

Authors

Moira Vieli¹, Victor E Staartjes¹, Hubert A J Eversdjik¹, Marlies P De Wispelaere², Jan Wolter A Oosterhuis³, Marc L Schröder¹

Affiliations

¹ Neurosurgery, Bergman Clinics, Amsterdam, NLD.
² Miscellaneous, Bergman Clinics, Amsterdam, NLD.
³ General Surgery, Haaglanden Medical Center, The Hague, NLD.

Abstract

Introduction As a possible treatment option for chronic lower back pain (CLBP) due to single-level degenerative disc disorder (DDD), the efficacy of anterior lumbar interbody fusion (ALIF) has been reviewed various times in the existing literature. Nevertheless, a scarcity of data exists pertaining to ALIF procedures carried out in a short-stay setting using an Enhanced Recovery after Surgery (ERAS) protocol, particularly concerning the safety. Methods Prospectively collected data are analyzed to study the efficacy and safety of short-stay ERAS ALIF in treatment of single-level DDD. Visual Analog Scale (VAS) in both back and leg pain along with the Oswestry Disability Index (ODI) were used to collect measure outcomes. The primary endpoint was a minimum clinically important difference (MCID) of ≥30% for the ODI at 12 months. Results Forty-four patients underwent surgery after failed long-term conservative treatment. MCID was achieved in 78%. Age was the only significant factor in association with MCID (p = 0.03), while gender, Modic changes, results of prognostic tests, prior surgery and smoking status had no significant influence on either MCID or change scores for any outcome measure. One complication in the form of transient new radiculopathy occurred in one patient (2.3%). Conclusion With overall positive outcomes in terms of both efficacy and safety, an ALIF procedure with subsequent implementation of an ERAS protocol in a short-stay setting can be an option for strictly selected patients with CLBP. Further study, however, possibly with a larger sample size, would be necessary to substantiate these findings.

Keywords: alif; anterior lumbar interbody fusion; chronic low back pain; clbp; degenerative disc disease; eras; fast-track; lumbar fusion; outpatient; short stay.