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  • Outcomes After ALIF versus TLIF For Treatment of Symtomatic L5-S1 Spondylolisthesis: A Prospective, Multi-Institutional Comparative Effectiveness Study

    Final Number:
    154

    Authors:
    Owoicho Adogwa M.D. M.P.H; Paul Thompson BS; Terence Verla; Kemp Knott BS; Ulysses Null; Kevin T. Huang BA; Joseph S. Cheng MD, MS; Robert E. Isaacs MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Anterior lumbar interbody fusion(ALIF) and Transforaminal lumbar interbody fusion (TLIF) are two techniques commonly used to achieve lumbar interbody arthrodesis. The primary aim of the study was to compare post-operative functional outcomes and complication rates following both surgical approaches.

    Methods: A nationwide, multi-institutional, prospective spine outcomes registry was utilized for this study. The study group included 519 patients with degenerative disc disease or spondylolisthesis at L5-S1; 219 patients underwent ALIF and 300 patients underwent TLIF. Patients completed the Oswestry Disability Index (ODI), MOS Short Form 36 (SF-36), and back and leg pain numerical rating scores before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts.

    Results: Compared to the ALIF cohort, patients undergoing TLIF were more likely to experience a post-operative complication (12.3% vs 7.8%, p=0.03); however, the likelihood of visceral/vascular injury was significantly higher in the ALIF cohort(P=0.002). At two years, both ALIF and TLIF patients showed similar 2-year improvement in VAS for back pain(ALIF: 2.98 ± 3.69 vs. TLIF: 2.51 ± 3.73,p=0.15) and leg pain (ALIF: 2.96 ± 4.09 vs. TLIF: 2.75 ± 4.32,p=0.57). Oswestry Disability Index (ALIF: 14.63 ± 20.36 vs. TLIF: 14.13 ± 22.45,p=0.79), and SF-36 PCS(ALIF: 6.45 ± 14.15 vs. TLIF: 7.88 ± 17.35,p=0.30) and SF-36 MCS(ALIF: 5.18 ± 20.92 vs. TLIF: 5.24 ± 22.28,p=0.97) were also improved. Notably, patients undergoing ALIF appear to have a more rapid reduction in one-year VAS back and leg pain scores.

    Conclusions: Both ALIF and TLIF result in similar long-term improvement on pain and functional disability. While ALIF was associated with lower post-operative complication rates and a more rapid reduction in one-year back pain, leg pain and functional disability, patients undergoing this procedure were more likely to experience intra-operative visceral or vascular injury.

    Patient Care: Our research will describe the differences in functional outcomes for ALIF and XLIF

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the differences in outcomes between ALIF and XLIF for lumbar interbody arthrodesis and 2) describe differences in complication rates of ALIF and XLIF

    References:

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