[Interbody fusion for active lumbar discopathy : long term functional outcome and comparison between the anterior and posterior approach].

Abstract

Background: There is limited evidence regarding the long-term functional outcomes of anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) in patients with refractory active lumbar discopathy (ALD).

Methods: We retrospectively surveyed 194 patients who underwent lumbar fusion for ALD using the Roland-Morris Disability Questionnaire (RMDQ) and Modified MacNab's Criteria (MMCQ) and reviewed medical records for complications.

Results: The cohort included 54 patients (median age: 53.5 years). Thirty underwent ALIF (L4L5: 4, L5S1: 20, L4S1: 6) and 24 had PLIF (L4L5: 8, L5S1: 12). Median follow-up was 83 (66-114) months. Excellent outcomes were more frequent in the ALIF group (34 % vs 21 %). RDQ scores were higher in the PLIF group (9 (3-17) vs 5 (0-11)). ALIF patients had fewer cases of proximal junctional kyphosis (7 % vs 25 %) but higher chronic analgesic use (33 % vs 17 %) and documented failed back surgery syndrome (13 % vs 0 %). No major complications were observed.

Conclusions: Both ALIF and PLIF are safe for treating recalcitrant ALD. ALIF may offer better long-term function and less disability, albeit with potentially higher analgesic use.