The Efficacy of Anterior Lumbar Interbody Fusion in Degenerative Disc Disease and Degenerative Spondylolisthesis: Comparative Review of 44 Single-Level Cases

Chung, Sang Ki; Ha, Seong Il; Lee, Sang Ho; Lim, Sang Rak; Lee, Ho Yeon

Abstract

OBJECTIVE
The authors conduct a retrospective study to evaluate the efficacy of anterior lumbar interbody fusion(ALIF) in treating degenerative disc disease(DDD) and degenerative spondylolisthesis(DS).
METHODS
During 1998, eighty-six patients underwent mini-retroperitoneal ALIF with Brantigan carbon cages. Among them, 19 patients were lost during the follow-up period and 23 patients underwent multilevel fusion procedures. The authors evaluated 44 single-level cases(31 with DDD; 13 with DS) with Macnab's criteria for clinical outcomes and the Criteria of Brantigan and Steffee for fusion results. The extent of slippage of patient with DS was not greater than grade 1. The mean follow-up period was 24 months.
RESULTS
The overall fusion rate was 88.6%(94% in DDD; 77% in DS). Based on the Macnab's criteria, excellent or good results were achieved in 38 of 44 patients(86.3%). Overall clinical outcome was significantly associated with preoperative diagnosis(p=0.03), radiologically demonstrated fusion(p=0.001), and subsidence of cages(p=0.03). In DDD sub-group, two cases of fusion failure and four of subsidence of cages belonged to excellent or good results. But, in DS sub-group, fusion failure or subsidence rate were significantly high and all three cases with poor result belonged to this sub-group. One of them underwent posterior operation.
CONCLUSION
ALIF is considered as a good surgical method for a patient with discogenic back pain caused by degenerative disc disease. But in degenerative spondylolisthesis, considering the comparatively poor clinical and radiological result, it seems that ALIF alone does not provide sufficient strength to overcome the instability. Despite the advantage of minimal invasiveness, more careful application of ALIF is needed in the of degenerative spondylolisthesis.