Comparison of ALIF and PLIF in Isthmic Lumbosacral Spondylolisthesis. A Multicenter Surveillance Study of 602 cases from the German Spine Registry (DWG Register)

Abstract

Background Isthmic spondylolisthesis most commonly occurs in the lumbosacral junction and can cause backpain and radicular pain as well as stiffness with progressive immobilization, with a negative impact on an individual's ability to work and quality of life. Multiple operative treatments are currently available. This study aims to compare complications, demography, and clinical features between anterior lumbar interbody fusion (ALIF) and posterior lumber body fusion (PLIF) in the operative treatment in isthmic spondylolisthesis.

Methods An analysis of data from the German spine registry (Deutsche Wirbelsäulengesellschaft [DWG]-Register) of patients who underwent operative treatment (PLIF and ALIF) for isthmic spondylolisthesis in the sacrolumbar junction in 170 departments between January 2017 and May 2021 was performed. Age, gender, American Society of Anesthesiologists (ASA) score, surgical approach, smoker/nonsmoker, as well as severeness of the spondylolisthesis according to the Meyerding classification were evaluated.

Results In total, 602 patients undergoing fusion in L5/S1 were identified in the registry, n = 570 PLIF (group 1) and n = 32 ALIF (group 2). A significant difference in the ASA score between the two groups was noted; group 1 had more patients suffering a more debilitating disease in comparison to group 2. There was no significant difference in gender, grade of spondylolisthesis, age, or smoking status. Significant differences were found in operative and postoperative variables and complications (fusion material, dura injury).

Conclusion No difference was found between the two procedures in terms of symptomatic benefit of patients who underwent either ALIF or PLIF. According to the DWG Register, PLIF was the preferred method to treat isthmic spondylolisthesis in the sacrolumbar junction in Germany. To compare these two spine fusion techniques, further studies with an adequate sample size and follow-up period are required.

Keywords

ALIF - PLIF - perioperative complications - spine registry

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Availability of Data and Material

The datasets generated and/or analyzed during the current study are available in the DWG Register home page repository: https://dwg.memdoc.org/.

Author Contributions

LMB is the lead author and was responsible for analysis development. MR contributed ideas and was responsible for revision and collection of data. VH and RS also contributed ideas. JMVR is the senior author with final extensive revision and writing of the manuscript. He is the analysis developer and has ownership of the idea. All the authors read and approved the final version of the manuscript.

Publikationsverlauf

Eingereicht: 04. September 2022

Angenommen: 07. März 2023

Artikel online veröffentlicht:
10. Juli 2023

• References

• 1 Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2015; 1 (01) 2-18
• 2 Ganju A. Isthmic spondylolisthesis. Neurosurg Focus 2002; 13 (01) E1
• 3 Jones TR, Rao RD. Adult isthmic spondylolisthesis. J Am Acad Orthop Surg 2009; 17 (10) 609-617
• 4 Bhalla A, Bono CM. Isthmic lumbar spondylolisthesis. Neurosurg Clin N Am 2019; 30 (03) 283-290
• 5 Beck AW, Simpson AK. High-grade lumbar spondylolisthesis. Neurosurg Clin N Am 2019; 30 (03) 291-298
• 6 Noorian S, Sorensen K, Cho W. A systematic review of clinical outcomes in surgical treatment of adult isthmic spondylolisthesis. Spine J 2018; 18 (08) 1441-1454
• 7 Fleege C, Arabmotlagh M, Rother W, Rauschmann M, Rickert M. ALIF- und PLIF-Interposition bei low-grade isthmischen Spondylolisthesen L5/S1: Langzeitvergleich der interkorporellen Fusionstechnik (ALIF - PLIF). Orthopade 2016; 45 (05) 760-769
• 8 Teng I, Han J, Phan K, Mobbs R. A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. J Clin Neurosci 2017; 44: 11-17
• 9 Phan K, Thayaparan GK, Mobbs RJ. Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion: systematic review and meta-analysis. Br J Neurosurg 2015; 29 (05) 705-711
• 10 Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J 2006; 15 (04) 391-402
• 11 Murray MR, Skovrlj B, Qureshi SA. Surgical treatment of isthmic spondylolisthesis. Clin Spine Surg 2016; 29 (01) 1-5
• 12 Schnake KJ, Rappert D, Storzer B. et al. Lumbale spondylodese: indikationen und techniken. Orthopade 2019; 48: 50-58
• 13 Zhang Q, Yuan Z, Zhou M, Liu H, Xu Y, Ren Y. A comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion: a literature review and meta-analysis. BMC Musculoskelet Disord 2014; 15: 367
• 14 Lee CW, Yoon KJ, Ha SS. Which approach is advantageous to preventing development of adjacent segment disease? Comparative analysis of 3 different lumbar interbody fusion techniques (ALIF, LLIF, and PLIF) in L4-5 spondylolisthesis. World Neurosurg 2017; 105: 612-622
• 15 Swan J, Hurwitz E, Malek F. et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. Spine J 2006; 6 (06) 606-614
• 16 Kim JS, Lee KY, Lee SH, Lee HY. Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis?. J Neurosurg Spine 2010; 12 (02) 171-177
• 17 Goz V, Weinreb JH, Schwab F, Lafage V, Errico TJ. Comparison of complications, costs, and length of stay of three different lumbar interbody fusion techniques: an analysis of the Nationwide Inpatient Sample database. Spine J 2014; 14 (09) 2019-2027
• 18 Viglione LL, Chamoli U, Diwan AD. Is stand-alone anterior lumbar interbody fusion a safe and efficacious treatment for isthmic spondylolisthesis of L5-S1?. Global Spine J 2017; 7 (06) 587-595
• 19 Wang SJ, Han YC, Liu XM. et al. Fusion techniques for adult isthmic spondylolisthesis: a systematic review. Arch Orthop Trauma Surg 2014; 136 (06) 777-784
• 20 Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 2001; 26 (05) 567-571
• 21 Rao PJ, Loganathan A, Yeung V, Mobbs RJ. Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study. Neurosurgery 2015; 76 (01) 7-23 , discussion 23–24
• 22 Kowalski RJ, Ferrara LA, Benzel EC. Biomechanics of bone fusion. Neurosurg Focus 2001; 10 (04) E2
• 23 Sebastian AS, Dalton D, Slaven SE. et al. What is the optimal surgical treatment for low-grade isthmic spondylolisthesis? ALIF or TLIF?. Clin Spine Surg 2020; 33 (10) 389-392
• 24 Cole CD, McCall TD, Schmidt MH, Dailey AT. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med 2009; 2 (02) 118-126
• 25 Lemcke J, Klötzer S, Klötzer R, Meier U. PLIF und ALIF zur operativen therapie der degenerativen lumbalen instabilität [PLIF and ALIF for the degenerative spondylolisthesis of the lumbar spine]. Z Orthop Ihre Grenzgeb 2007; 145 (01) 48-54
• 26 Park JS, Kim YB, Hong HY, Hwang SN. Comparison between posterior and transforaminal approaches for lumbar interbody fusion. J Korean Neurosurg Soc 2005; 37: 5