Two-Year Clinical and Radiological Results of the Anterior Lumbar Fusion: A Single-Surgeon Case Series

Introduction ALIF is enjoying something of a renaissance in the treatment of lumbar DDD. We reported the largest case series using a uniform technique, implant and graft material. Study Design Uncontrolled Case Series of a single cohort under the care of a single surgeon. Objective The goal of this study is to review the ability of ALIF to provide patients with successful outcomes using clinical and radiographic analysis. Methods Patients who had previously undergone a single or multilevel ALIF performed by a single surgeon for degenerative or post-traumatic aetiology, at a single institution between 2008 and 202l were retrospectively reviewed. Clinical outcomes were determined according to patient's changes in preoperative and post-operative Oswestry Disability Index (ODI). Radiographic outcomes were assessed by plain radiographs, CT scans and clinical examination one year into the post-operative period. Results 463 patients met inclusion criteria. 102 patients were lost to follow up. The average age was 45.89 ± 12.5 years. A total of 340 patients (94.2%) had attained successful fusion based on plain radiographs and clinical exam. However, 21 patients (5.8%) developed pseudoarthrosis. Overall, ODI scores changed from 40.31% ± 15.86 to 12.65% ± 14.56. Discussion We present the largest case series currently reported demonstrating patient satisfaction and clinical success equivalent to more commonly performed orthopedic procedures. Conclusion Our study has demonstrated that the ALIF remains a highly successful surgical approach that provides patients with a high degree of satisfaction. The union rates for the anterior approach in this study are consistent with literature values between 90 and 95%. We also found that vertebrae are more likely to unite when performing a standalone ‘single level’ ALIF compared to an ALIF being performed as part of a multilevel fusion.