Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months

J Spinal Disord Tech. 2012 Oct;25(7):362-9. doi: 10.1097/BSD.0b013e3182263d91.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Bone Screws
  • Female
  • Follow-Up Studies
  • Humans
  • Intervertebral Disc Degeneration / diagnostic imaging
  • Intervertebral Disc Degeneration / surgery*
  • Low Back Pain / diagnostic imaging
  • Low Back Pain / surgery*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Pain Measurement
  • Patient Satisfaction
  • Prospective Studies
  • Radiography
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods*
  • Treatment Outcome