An article published in Spine examines the effectiveness of anterior lumbar interbody fusion for degenerative disc disease in the lumbar spine.
The researchers reviewed a consecutive series of patients who had one- and two-level ALIF between 2005 and 2010 using recombinant human bone morphogenetic protein-2. Here are five findings from the study:
1. Patients reported significant Oswestry Disability Index and visual analogue scale improvements two years after surgery. A 2012 study published in the Journal of Spinal Disorders and Techniques showed that VAS and ODI improved significantly overtime for single-level ALIF and anteroposterior lumbar fusion, but patient satisfaction consistently ranked higher in the ALIF group. The study authors suggested performing a standalone ALIF in cases with single-level DDD.
2. The two-year postoperative disc height was significantly greater than the preoperative disc height at the fused level. A 2011 study examined whether disc space height of the fused segment affects adjacent degeneration in ALIF, finding the decreased disc space height adversely aggravated the adjacent segment degeneration.
3. Patients did not report a significant difference at the adjacent levels to fusion. A study published in the European Spine Journal in 2009 reported a low incidence of adjacent segment disease after lumbar or lumbosacral fusion requiring surgery. However, the study authors note, "In determining fusion levels, it would be desirable to save the distal adjacent segment unless it shows significant degenerative changes or neural encroachment because the incidence of distal ASD is much lower than that of proximal ASD in floating fusion. Preexisting facet degeneration may be associated with a high risk of adjacent segment problems."
4. Around 93 percent of the patients satisfied fusion criteria based on the mean optical density. Another study published in Orthopedics in 2009 compared ALIF and posterior lumbar interbody fusion, finding both had similar fusion and functional outcomes. However, ALIF had shorter surgical times and decreased blood loss.
5. The Intraoperative time, estimated blood loss and hospital stay was significantly fewer with one-level and two-level ALIFs than 360 degree fusions and total disc replacement. "Standalone ALIF used to treat DDD can produce comparative clinical and functional outcomes," concluded the study authors.
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