Back pain outcomes after minimally invasive anterior lumbar interbody fusion: a systematic review

Neurosurg Focus. 2020 Sep;49(3):E3. doi: 10.3171/2020.6.FOCUS20385.


Objective: Minimally invasive anterior lumbar interbody fusion surgery (MIS ALIF) is a technique that restores disc height and lumbar lordosis through a smaller exposure and less soft-tissue trauma compared to open approaches. The mini-open and laparoscopic assistance techniques are two main forms of MIS ALIF. The authors conducted a systematic review that sought to critically summarize the literature on back pain following MIS ALIF.

Methods: In March 2020, the authors searched the PubMed, Web of Science, and Cochrane Library databases for studies describing back pain visual analog scale (VAS) outcomes after MIS ALIF. The following exclusion criteria were applied to studies evaluated in full text: 1) the study included fewer than 20 patients, 2) the mean follow-up duration was shorter than 12 months, 3) the study did not report back pain VAS score as an outcome measure, and 4) MIS ALIF was not studied specifically. The methodology for the included studies were evaluated for potential biases and assigned a level of evidence.

Results: There were a total of 552 patients included from 13 studies. The most common biases were selection and interviewer bias. The majority of studies were retrospective. The mean sample size was 42.3 patients. The mean follow-up duration was approximately 41.8 months. The mean postoperative VAS reduction was 5.1 points. The mean VAS reduction for standalone grafts was 5.9 points, and 5.0 points for those augmented with posterior fixation. The most common complications included bladder or urinary dysfunction, infection, and hardware-related complications.

Conclusions: This was a systematic review of back pain outcomes following MIS ALIF. Back pain VAS score was reduced postoperatively across all studies. The complication rates were low overall. MIS ALIF is safe and effective at reducing back pain in appropriate patient populations.

Keywords: ALIF = anterior lumbar interbody fusion; DDD = degenerative disc disease; MIS = minimally invasive surgery; MISS = minimally invasive spine surgery; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; VAS = visual analog scale; anterior lumbar interbody fusion; laparoscopic; mini-open; minimally invasive surgery; visual analog scale.

Publication types

  • Systematic Review

MeSH terms

  • Back Pain / diagnostic imaging
  • Back Pain / surgery*
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery*
  • Minimally Invasive Surgical Procedures / methods*
  • Minimally Invasive Surgical Procedures / trends
  • Pain Measurement / methods*
  • Pain Measurement / trends
  • Retrospective Studies
  • Spinal Fusion / methods*
  • Spinal Fusion / trends
  • Treatment Outcome