Short- and Mid-Term Outcomes Following ALIF and TLIF in L5-S1 Isthmic Spondylolisthesis Patients.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2025-03-06 DOI:10.14444/8696

Jialun Chi, Kate S Woods, Ved A Vengsarkar, Zhiwen Xu, Hanzhi Yang, Abhishek Kumar, Yi Zhang, Zhichang Zhang, Jesse Wang, Lawal Labaran, Li Jin, Xudong Li

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Abstract

Background: A limited number of studies have compared the outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF) for the treatment of isthmic spondylolisthesis. This study aims to compare postoperative complications between these two surgical approaches.

Methods: A retrospective review was performed using a large national database. The study population included all patients older than 18 years who underwent single-level ALIF or TLIF with a diagnosis of L5 to S1 isthmic spondylolisthesis. A 1:2 propensity score was used to match ALIF and TLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Multivariate logistic regression was used to compare 3-month and 2-year medical and surgical complications, including 5-year reoperation rates.

Results: Five hundred and seventy-eight ALIF patients were paired with 1,156 TLIF patients following the match. The analysis revealed a higher 3-month ileus rate in ALIF patients (P = 0.009) and a lower, though not significant difference in, reoperation rate for ALIF within 2 years at 7.1% compared with TLIF at 7.7% (P = 0.696). Five-year reoperation rates were comparable (9.5% vs 10.8%; P = 0.612).

Conclusions: Aside from the increased rate of ileus in the ALIF group, there was no significant difference in both short- and mid-term complications, including overall reoperation rate, between the 2 techniques. Spine surgeons should select the optimal technique for a given patient.

Clinical relevance: ALIF and TLIF offer comparable mid-term postoperative outcomes for treating 1-level L5/S1 isthmic spondylolisthesis.

Level of evidence: 3:

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ALIF和TLIF治疗L5-S1峡部滑脱患者的中短期预后

背景：有限数量的研究比较了前路腰椎椎体间融合术（ALIF）和经椎间孔腰椎椎体间融合术（TLIF）治疗峡部滑脱的结果。本研究旨在比较两种手术方式的术后并发症。方法：使用大型国家数据库进行回顾性研究。研究人群包括所有年龄大于18岁、诊断为L5至S1型峡部滑脱且接受单水平ALIF或TLIF的患者。使用1:2倾向评分来匹配ALIF和TLIF队列的年龄、性别和相关合并症，包括吸烟状况。采用多因素logistic回归比较3个月和2年的内科和外科并发症，包括5年的再手术率。结果：578例ALIF患者与1156例TLIF患者配对。分析显示ALIF患者的3个月肠梗阻率较高（P = 0.009）， ALIF患者2年内再手术率为7.1%，低于TLIF患者的7.7% (P = 0.696)，但差异无统计学意义。5年再手术率比较(9.5% vs 10.8%；P = 0.612)。结论：ALIF组除肠梗阻发生率升高外，两种技术在中短期并发症及总再手术率方面均无显著差异。脊柱外科医生应该为特定的病人选择最佳的技术。临床相关性：ALIF和TLIF治疗1级L5/S1峡部滑脱的中期术后疗效相当。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.