Journal List > J Korean Soc Spine Surg > v.20(4) > 1075995

Kim, Cho, and Yu: The Result of Minimal Invasive Anterior Lumbar Interbody Fusion with Posterior Lumbar Interbody Fusion on Degenerative Lumbar Flat Back Disease

Abstract

Study Design

Restrospective study.

Objectives

We tried to find out the effects of minimal invasive anterior lumbar interbody fusion (ALIF) combined with posterior lumbar interbody fusion for degenerative lumbar flat back disease.

Summary of Literature Review

ALIF combined with PLIF is effective in correcting lumbar lordosis. However, the complication rate with conventional ALIF is higher on the lower level.

Materials and Methods

21 cases (9 men and 12 women, 46-83 years of age) of having undergone minimal invasive ALIF and PLIF due to degenerative flat back disease were reviewed. The followup period was an average of 23 months. We compared the pre-postoperative pain, the functional outcome, the correction of sagittal imbalance and lordotic angle.

Results

At final followup, 21 cases with the solid fusion experienced a great improvement in their lower back pain(VAS: 7.3 → 2.6) and leg pain (VAS: 7.0 → 2.7) and ODI(38.5 → 18.1). And we experienced correction in sagital imbalance. On levels with anterior fusion, lordotic angle is corrected 6.3 degrees while on levels with posterior fusion, lordotic angle is corrected 9.7 degrees. Plumb line is corrected by 5.2cm, and no complication was found in the followup period.

Conclusions

Combined surgery with minimal invasive anterior lumbar interbody fusion and posterior fusion is an effective procedure on patients who need long level surgery for correction of lumbar deformity and decompression.

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Figures and Tables%

Fig. 1.
On left lateral position, incision for minimal invasive anterior interbody fusion (ALIF) has been applied parallel to iliac crest.
jkss-20-149f1.tif
Fig. 2.
This graph shows the improvement of pain after surgery with Visual Analogue Scale (VAS)
jkss-20-149f2.tif
Fig. 3.
This graph shows the functional outcome with Oswestry Disability Index(ODI)
jkss-20-149f3.tif
Fig. 4.
The lordotic angle has been corrected after ALIF and PLIF combined surgery. And PLIF has more corrective effect.
jkss-20-149f4.tif
Fig. 5.
A male aged 66 yrs had multiple spinal stenosis. (A) Preoperative AP and lateral radiograph show spinal stenosis with flat back. (B) Postoperative AP and lateral radiograph with minimal invasive ALIF for L2-L4 and PLIF for L4-L5 show correction of lordotic angle and foraminal stenosis.
jkss-20-149f5.tif
Table 1.
Demographic Characteristics of 21 Patients
Data No. Percent
Sex
Male 9 42.9
Female 12 57.1
Age
<50 yr 2 9.5
51-60 yr 4 19.0
61-70 yr 7 33.3
71-80 yr 7 33.3
80< yr 1 4.8
Anterior Fusion level (ALIF)
L1-L2 2 9.5
L1-L3 1 4.8
L1-S1 1 4.8
L2-L3 3 14.3
L2-L4 3 14.3
L2-L5 1 4.8
L2-S1 3 14.3
L3-L4 2 9.5
L3-L5 2 9.5
L4-L5 1 4.8
L3-L4, L5-S1 2 9.5
Posterior Fixation level
T7-L2 1 4.8
T10-S1 1 4.8
T12-L5 1 4.8
L1-L2 1 4.8
L1-L4 1 4.8
L1-S1 2 9.5
L2-L5 5 23.8
L2-S1 5 23.8
L3-S1 4 19.0
Diagnosis
Multiple Spinal stenosis 6 28.6
Adjacent segment degeneration (ASD) 6 33.3
Traumatic kyphosis 1 4.8
Pseudoarthrosis 2 9.5
LDK 2 9.5
Degenerative scoliosis 1 4.8
Multiple Degenerative disc disease 2 9.5
Postoperative flat back with ASD 1 4.8
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