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Stand-alone Anterior Versus Anteroposterior Lumbar Interbody Single-level Fusion After a Mean Follow-up of 41 Months

Strube, Patrick MD; Hoff, Eike MD; Hartwig, Tony MD; Perka, Carsten F. MD; Gross, Christian MD; Putzier, Michael MD

Journal of Spinal Disorders & Techniques: October 2012 - Volume 25 - Issue 7 - p 362–369
doi: 10.1097/BSD.0b013e3182263d91

Study Design Prospective cohort study comparing evaluations of single-level anterior lumbar interbody fusion (ALIF) versus anteroposterior lumbar fusion (APLF).

Objective To clinically and radiologically compare the outcome after angle-stable, locked, stand-alone ALIF with that obtained after APLF, in cases with degenerative disc disease (DDD).

Summary of Background Data Fusion rates have been reported to be highest after interbody fusion with transpedicular fixation. However, transpedicular fixation is linked to significant damage of the paravertebral muscles, to screw displacement-related neurological and vascular complications, and to an increased rate of adjacent segment degeneration. When performed as a stand-alone procedure, the disadvantages of transpedicular fixation can be completely avoided by ALIF.

Methods Eighty patients with chronic low-back pain due to a single-level DDD (Modic ≥2) and facet joint arthritis (Fujiwara ≥3) were enrolled in this study. Forty patients received an anteroposterior fusion (ALIF with transpedicular fixation: APLF group) and 40 patients (ALIF group) were treated with a stand-alone ALIF using the Synfix-LR device. At 7 days, 3, 6, 12, and 24 months, and at a mean follow-up of 41 months, patients were clinically (visual analog scale, Oswestry Low Back Pain Disability Index, satisfaction) and radiologically (x-ray, and at 12 months, thin-slice computed tomography) compared.

Results Blood loss and duration of surgery were significantly lower in the ALIF group (P<0.001). Visual analog scale and Oswestry Low Back Pain Disability Index improved significantly over time (analysis of variance, P<0.001) in both groups, but both scores were significantly better in ALIF group (analysis of variance, P<0.001). Patients' satisfaction consistently ranked higher in the ALIF group (P=0.042 at 12 mo). No significant difference was found in the fusion rate throughout the study.

Conclusions Stand-alone ALIF leads to better clinical results than APLF, without differences in fusion rates after 41 months. Therefore, when a posterior approach is not needed for decompression or reposition, we suggest performing a stand-alone ALIF in cases with single-level DDD.

Center for Musculoskeletal Surgery, Clinic for Orthopaedics, Charité-University Medicine Berlin, Germany

No funding was received for this study from industry or from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

The authors declare no conflict of interest.

The conduct of this study was approved by the local ethics committee under decision No. 2015/Si. 280 for the APLF group and under decision EA1/055/08 for the ALIF group.

Reprints: Patrick Strube, MD, Center for Musculoskeletal Surgery, Clinic for Orthopaedics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany (e-mail:

Received January 3, 2011

Accepted May 25, 2011

© 2012 Lippincott Williams & Wilkins, Inc.