Anterior Lumbar Interbody Fusion (ALIF): Complications and radiological outcomes

Abstract

Introduction: Anterior lumbar interbody fusion (ALIF) is a well-established treatment. Using poly-ether-ether-ketone (PEEK) cages for ALIF procedure take advantage of the relative radiolucency of PEEK cages .The goal of this study was to determine the radiological outcomes and complications after ALIF surgery. Materials & Methods: Retrospective review of patients with ALIF (PEEK cage) surgery. Complications were noted. Bone union determined with Bridwell classification. Pre and post-operative X-rays, X-rays at the last follow-up reviewed. Anterior-posterior disc space height, segmental lordosis at the ALIF levels and global lumbar lordosis were measured. Results: 56 patients (M:25, F:31) and 80 ALIF cages were reviewed. The respective median age of surgery and follow-up duration (months) for the 3 subgroups were as follows: 47(37-54) /14(12-24) (disc degeneration), 45(40-52) /22(14-27) (listhesis), 57(51-62) /17(16-25) (non-union). Number of complications associated with the anterior approach was 9/56 or 16%. Bridwell fusion status was classified as 1 in 72 cages, 2 in 6 cages and 4 in 2 cages. The anterior disc space height and posterior disc space height L3/L4, L4/L5, L5/S1 significantly increased from preoperatively to immediately postoperatively and compared to the distance at last follow up. The anterior disc space height and posterior disc space height L4/L5, L5/S1 decreased significantly from immediately postoperatively to last follow-up. Only for the L5/S1 level did the segmental lordosis increase significantly from preoperatively to immediately postoperatively and compared to the angle at last follow-up. Conclusions: The use of ALIF (PEEK cage) with posterior fixation resulted in very low non-union rate (2.5%). The approach related complications are comparable to the literature.