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

Patrick C. Hsieh*, Tyler R. Koski, Brian A. O'Shaughnessy, Patrick Sugrue, Sean Salehi, Stephen Ondra, John C. Liu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

196 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)379-386
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume7
Issue number4
DOIs
StatePublished - Oct 2007

Keywords

  • Anterior lumbar interbody fusion
  • Degenerative spine disease
  • Lumbar spondylosis
  • Sagittal balance
  • Transforaminal lumbar interbody fusion

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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