Evaluating the Benefits of Stand Alone Anterior Lumbar Interbody Fusion

Introduction: Anterior Lumbar Interbody fusion (ALIF) is a commonly performed procedure for treatment of degenerative lumbar conditions. They are often followed by posterior fixation for additional stability. ALIF cages that do not require posterior fixation are a recent development and few studies have explored their effect on patient outcome.

Objective: Determine if stand Alone ALIFs show improved PROMs due to lack of posterior chain disruption

Methods: A total of 343 patients that underwent 1-level ALIF were included. Patients were reviewed for Demographics, operative characteristics, post-operative course, and PROMs. Patients were compared based on if they received posterior fixation after ALIF. Independent-samples T-test and Chi-square analysis were performed for the cohort, significance set to p< 0.05).

Results: 23 patients had stand alone ALIFs compared to 320 that had ALIFs with posterior fixation (A/P ALIFs). On average, patients that underwent standalone ALIF were younger than those who had A/P ALIFs (44.4± 12.6y vs 50.5± 12.4y, p=0.02). Stand alone ALIFs demonstrated decreased operative time (138± 45min vs 266± 78min, p=0.001), estimated blood loss (EBL, 101± 51ml vs 261± 320ml, p=0.001), and patient length of stay (LOS, 1.6± 1.0days vs 3.3± 1.5days, p=0.001) compared to A/P ALIFs. Average baseline EQ5D was lower in the Stand alone Cohort compared to the A/P (0.43±0.14 vs 0.66±0.22, p=0.001). Other baseline PROMs were similar between groups. Standalone ALIFs demonstrated quicker recovery times with improved 3-month PROMs, including ODI (15.3±8.1 vs 29.7±21, p=0.001), VAS (2.3±2.0 vs 3.6±1.7, p=0.04), and EQ5D (0.68±0.14 vs 0.53±0.22,p=0.01); however, these differences subsided at the 1-year time point. No differences in intraoperative complications, post-operative complications, or reoperations were observed.

Conclusion: Stand Alone ALIFs demonstrate superior to A/P ALIFs with regard to EBL, LOS, and operative time, but with similar complication rates. Standalone ALIF patients also demonstrated a higher rate of recovery with more improved 3-month PROMs, however, as more cases continue to be conducted, a more throughout evaluation and comparison would be beneficial.