Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

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Object

A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.

Methods

The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.

Results

Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3° and lumbar lordosis by 6.2°, whereas TLIF decreased the local disc angle by 0.1° and lumbar lordosis by 2.1°.

Conclusions

The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.

Abbreviations used in this paper:ALIF = anterior lumbar inter-body fusion; CI = confidence interval; IAR = instantaneous axis of rotation; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale.
Article Information

Contributor Notes

Address correspondence to: Patrick C. Hsieh, M.D., 676 North St. Clair, Suite 2210, Chicago, Illinois 60611. email: phsieh@md.northwestern.edu.
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References
  • 1

    Barrick WTSchofferman JAReynolds JBGoldthwaite NDMcKeehen MKeaney D: Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. Spine 25:8538572000

    • Search Google Scholar
    • Export Citation
  • 2

    Beutler WJPeppelman WC Jr: Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome. Spine J 3:2892932003

    • Search Google Scholar
    • Export Citation
  • 3

    Brislin BVaccaro AR: Advances in posterior lumbar interbody fusion. Orthop Clin North Am 33:3673742002

  • 4

    Burke PJ: Anterior lumbar interbody fusion. Radiol Technol 72:4234302001

  • 5

    Burkus JKGornet MFDickman CAZdeblick TA: Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages. J Spinal Disord Tech 15:3373492002

    • Search Google Scholar
    • Export Citation
  • 6

    Burkus JKSchuler TCGornet MFZdeblick TA: Anterior lumbar interbody fusion for the management of chronic lower back pain: current strategies and concepts. Orthop Clin North Am 35:25322004

    • Search Google Scholar
    • Export Citation
  • 7

    Choi JYSung KH: Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages. Eur Spine J 15:16222006

    • Search Google Scholar
    • Export Citation
  • 8

    Duggal NMendiondo IPares HRJhawar BSDas KKenny KJ: Anterior lumbar interbody fusion for treatment of failed back surgery syndrome: an outcome analysis. Neurosurgery 54:6366442004

    • Search Google Scholar
    • Export Citation
  • 9

    Farcy JPSchwab FJ: Management of flatback and related kyphotic decompensation syndromes. Spine 22:245224571997

  • 10

    Figueiredo NMartins JWArruda AASerra ARFigueiredo MADiniz RC: TLIF-transforaminal lumbar interbody fusion. Arq Neuropsiquiatr 62:8158202004

    • Search Google Scholar
    • Export Citation
  • 11

    Freemont AJWatkins ALe Maitre CBaird PJeziorska MKnight MT: Nerve growth factor expression and innervation of the painful intervertebral disc. J Pathol 197:2862922002

    • Search Google Scholar
    • Export Citation
  • 12

    Fritzell PHagg OWessberg PNordwall A: Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27:113111412002

    • Search Google Scholar
    • Export Citation
  • 13

    Fritzell PHagg OWessberg PNordwall A: 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:252125342001

    • Search Google Scholar
    • Export Citation
  • 14

    Glassman SDBerven SBridwell KHorton WDimar JR: Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:6826882005

    • Search Google Scholar
    • Export Citation
  • 15

    Glassman SDBridwell KDimar JRHorton WBerven SSchwab F: The impact of positive sagittal balance in adult spinal deformity. Spine 30:202420292005

    • Search Google Scholar
    • Export Citation
  • 16

    Hackenberg LHalm HBullmann VVieth VSchneider MLiljenqvist U: Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 14:5515582005

    • Search Google Scholar
    • Export Citation
  • 17

    Harms JRolinger H: [A one-stage procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion.]. Z Orthop Ihre Grenzgeb 120:3433471982. (Ger)

    • Search Google Scholar
    • Export Citation
  • 18

    Harms JGJeszenszky D: The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88991998

  • 19

    Humphreys SCHodges SDPatwardhan AGEck JCMurphy RBCovington LA: Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 26:5675712001

    • Search Google Scholar
    • Export Citation
  • 20

    Korkala OGrönblad MLiesi PKaraharju E: Immunohistochemical demonstration of nociceptors in the ligamentous structures of the lumbar spine. Spine 10:1561571985

    • Search Google Scholar
    • Export Citation
  • 21

    La Grone MO: Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am 19:3833931988

  • 22

    Lowe TGTahernia ADO'Brien MFSmith DA: Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31382002

    • Search Google Scholar
    • Export Citation
  • 23

    Lund TOxland TRJost BCripton PGrassmann SEtter C: Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg Br 80:3513591998

    • Search Google Scholar
    • Export Citation
  • 24

    Madan SSBoeree NR: Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 12:5675752003

    • Search Google Scholar
    • Export Citation
  • 25

    Mayer HM: The ALIF concept. Eur Spine J 9:1 SupplS35S432000

  • 26

    McAfee PCDeVine JGChaput CDPrybis BGFedder ILCunningham BW: The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases. Spine 30:6 SupplS60S652005

    • Search Google Scholar
    • Export Citation
  • 27

    Moskowitz A: Transforaminal lumbar interbody fusion. Orthop Clin North Am 33:3593662002

  • 28

    Mummaneni PVHaid RWRodts GE: Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:24302004

    • Search Google Scholar
    • Export Citation
  • 29

    Pavlov PWMeijers Hvan Limbeek JJacobs WCLemmens JAObradov-Rajic M: Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation. Spine 29:189319002004

    • Search Google Scholar
    • Export Citation
  • 30

    Potter BKLenke LGKuklo TR: Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am 86:179318082004

  • 31

    Rosenberg WSMummaneni PV: Transforaminal lumbar inter-body fusion: technique, complications, and early results. Neurosurgery 48:5695752001

    • Search Google Scholar
    • Export Citation
  • 32

    Salehi SATawk RGanju ALaMarca FLiu JCOndra SL: Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurgery 54:3683742004

    • Search Google Scholar
    • Export Citation
  • 33

    Sasso RCBest NMMummaneni PVReilly TMHussain SM: Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures. Spine 30:6706742005

    • Search Google Scholar
    • Export Citation
  • 34

    Shields LBRaque GHGlassman SDCampbell MVitaz THarpring J: Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion. Spine 31:5425472006

    • Search Google Scholar
    • Export Citation
  • 35

    Stephens GCYoo JUWilbur G: Comparison of lumbar sagittal alignment produced by different operative positions. Spine 21:180218071996

    • Search Google Scholar
    • Export Citation
  • 36

    Wiggins GCOndra SLShaffrey CI: Management of iatrogenic flat-back syndrome. Neurosurg Focus 15:E82003

  • 37

    Yang BPOndra SL: A Method for calculating the exact angle required during pedicle subtraction osteotomy for fixed sagittal deformity: comparison with the trigonometric method. Neurosurgery 59:4 SupplONS458ONS4632006

    • Search Google Scholar
    • Export Citation
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