Stand-alone ALIF for degen spondylolisthesis
Finn Ghent, Prashanth Rao, Lee Keegan, Rajesh Reddy and Ralph J. Mobbs, Global Spine Journal (2015) 5
Abstract
We sought to evaluate the clinical and radiologic efficacy of stand-alone anterior lumbar interbody fusion(ALIF) for low grade degenerative spondylolisthesis, the favoured surgical management approach at our institution. The optimal approach for surgical management of spondylolisthesis remains contentious.
We performed a prospective analysis of all consecutive patients with low grade lumbar spondylolisthesis who underwent ALIF between 2009 and 2013 by a single surgeon (n = 27). The mean age was 64.9 years with a male to female ratio of 14:13. There were 32 levels operated and the average preoperative spondylolisthesis was 14.8%, which reduced to 6.4% postoperatively and 9.4% at the latest follow-up (p= 0001).
Postoperative disc height was increased to 175% of preoperative values and was statistically significant(p< 0.001) and remained improved with an overall change of 139% at the latest follow-up. The radiological fusion rate was 91%. The 12-Item Short Form Health Survey (SF-12) mental and physical component summary improved from 31.7 to 43.0 (p= 0.007) and from 35.4 to 51.7 (p= 0.0026), respectively.
The mean visual analogue scale pain score improved from 7.6 to 2.2 (p< 0.001), and the mean Oswestry disability index improved from 56.9 to 17.8% (p< 0.0001). The overall clinical success rate was 93%.The posterior disc height correlated with spondylolisthesis reduction (p= 0.04) and the only clinical factor affecting reduction was body mass index (p= 0.04). The present study provides encouraging short term results for stand-alone ALIF as a procedure for low grade lumbar degenerative spondylolisthesis.
Future studies should include adequately powered, prospective, multicentre registry studies with longterm follow-up to allow a better assessment of the relative benefits and risks.
