The outcomes after Anterior Lumbar Interbody Fusion(ALIF): Our experience

Abstract Background:Anterior lumbar interbody fusion (ALIF) is a well-established treatment with various advantages and disadvantages. One specific advantage of ALIF combined with posterolateral fusion is the high union rate. Using poly-ether-ether-ketone (PEEK) cages for ALIF procedure takes advantage of the relative radiolucency of PEEK cages .The goal of this study was to determine the radiological outcomes and complications after ALIF surgery. Methods: Retrospective review of patients with ALIF (PEEK cage) surgery. Complications were noted. Bone union determined with Bridwell classification. Pre and post-operative X-rays, X-rays at the last follow-up reviewed. Anterior-posterior disc space height, segmental lordosis at the ALIF levels, lordosis of global lumbar columna measured. Results: 56 patients (M:25, F:31) and 80 ALIF cages were reviewed. The respective median age of surgery and follow-up duration(months) for these subgroups were; 47(37-54) / 14(12-24), 45(40-52) / 22(14-27), 57(51-62) / 17(16-25). The number of complications associated with the anterior approach were 9/56 or 16,0%. Bridwell fusion status were; 1 in 72 cages, 2 in 6 cages and 4 in 2 cages. The anterior disc space height and posterior disc space height L3/L4, L4/L5, L5/S1 significantly increased from preoperatively to immediately postoperatively and compared to the distance at last follow up. The anterior disc space height and posterior disc space height L4/L5, L5/S1 decreased significantly from immediately postoperatively to last follow-up. In L4/L5, the decrease in posterior disc space height from immediately postoperatively to last follow up was insignificant. Only for the L5/S1 level did the segmental lordosis increase significantly from preoperatively to immediately postoperatively and compared to the angle at last follow-up. No significant changes were noted in the lordosis of global lumbar columna measurements.Conclusions: The use of ALIF (PEEK cage) with posterior fixation resulted in very low non-union rate (2,5%). The approach related complications are comparable to the literature.