Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up
Objective Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the r...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-09-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13812 |
| _version_ | 1797693891312353280 |
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| author | Jinping Liu Rong Xie Cynthia T. Chin Priya Rajagopalan Ping‐Guo Duan Bo Li Shane Burch Sigurd H. Berven Praveen V. Mummaneni Dean Chou |
| author_facet | Jinping Liu Rong Xie Cynthia T. Chin Priya Rajagopalan Ping‐Guo Duan Bo Li Shane Burch Sigurd H. Berven Praveen V. Mummaneni Dean Chou |
| author_sort | Jinping Liu |
| collection | DOAJ |
| description | Objective Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. Methods Ninety‐six patients who underwent single‐level L5‐S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan–Steffee–Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow‐up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t‐test or chi‐square test. Results The mean follow‐up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow‐up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow‐up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999). Conclusions With a minimum 2‐year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups. |
| first_indexed | 2024-03-12T02:50:13Z |
| format | Article |
| id | doaj.art-53bab79eae5241bba67271a0287aacd4 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-12T02:50:13Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-53bab79eae5241bba67271a0287aacd42023-09-04T04:41:45ZengWileyOrthopaedic Surgery1757-78531757-78612023-09-011592334234110.1111/os.13812Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐UpJinping Liu0Rong Xie1Cynthia T. Chin2Priya Rajagopalan3Ping‐Guo Duan4Bo Li5Shane Burch6Sigurd H. Berven7Praveen V. Mummaneni8Dean Chou9Department of Neurosurgery, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu ChinaDepartment of Neurosurgery University of California San Francisco San Francisco CA USADepartment of Radiology University of California San Francisco San Francisco CA USADepartment of Radiology University of California San Francisco San Francisco CA USADepartment of Neurosurgery University of California San Francisco San Francisco CA USADepartment of Neurosurgery University of California San Francisco San Francisco CA USADepartment of Orthopaedic Surgery University of California San Francisco San Francisco CA USADepartment of Orthopaedic Surgery University of California San Francisco San Francisco CA USADepartment of Neurosurgery University of California San Francisco San Francisco CA USADepartment of Neurosurgery Columbia University New York USAObjective Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. Methods Ninety‐six patients who underwent single‐level L5‐S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan–Steffee–Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow‐up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t‐test or chi‐square test. Results The mean follow‐up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow‐up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow‐up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999). Conclusions With a minimum 2‐year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.https://doi.org/10.1111/os.13812ALIFArthrodesisPseudarthrosisFusion gradeSolid fusionTLIF |
| spellingShingle | Jinping Liu Rong Xie Cynthia T. Chin Priya Rajagopalan Ping‐Guo Duan Bo Li Shane Burch Sigurd H. Berven Praveen V. Mummaneni Dean Chou Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up Orthopaedic Surgery ALIF Arthrodesis Pseudarthrosis Fusion grade Solid fusion TLIF |
| title | Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up |
| title_full | Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up |
| title_fullStr | Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up |
| title_full_unstemmed | Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up |
| title_short | Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up |
| title_sort | comparison of lumbosacral fusion grade in patients after transforaminal and anterior lumbar interbody fusion with minimum 2 year follow up |
| topic | ALIF Arthrodesis Pseudarthrosis Fusion grade Solid fusion TLIF |
| url | https://doi.org/10.1111/os.13812 |
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