J Korean Soc Spine Surg.  2013 Dec;20(4):149-155. 10.4184/jkss.2013.20.4.149.

The Result of Minimal Invasive Anterior Lumbar Interbody Fusion with Posterior Lumbar Interbody Fusion on Degenerative Lumbar Flat Back Disease

• Kim EH
• Cho WI
• Yu JW

• KMID: 1896943
• DOI: http://doi.org/10.4184/jkss.2013.20.4.149

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 follow-up 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 follow-up, 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 follow-up 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.

Keyword

Degenerative lumbar flat back; Minimal invasive anterior lumbar interbody fusion (ALIF); Posterior lumbar interbody fusion (PLIF)

MeSH Terms

Animals
Congenital Abnormalities
Decompression
Female
Follow-Up Studies
Humans
Leg
Lordosis
Male

Figure

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  Fig. 1. On left lateral position, incision for minimal invasive anterior interbody fusion (ALIF) has been applied parallel to iliac crest.

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  Fig. 2. This graph shows the improvement of pain after surgery with Visual Analogue Scale (VAS)

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  Fig. 3. This graph shows the functional outcome with Oswestry Disability Index(ODI)

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  Fig. 4. The lordotic angle has been corrected after ALIF and PLIF combined surgery. And PLIF has more corrective effect.

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  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.

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