Rao Prashanth J, Loganathan Ajanthan, Yeung Vivian, Mobbs Ralph J
*Neurospine Clinic, Randwick, Sydney, New South Wales, Australia; ‡Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia; §University of New South Wales, Sydney, Australia.
Neurosurgery. 2015 Jan;76(1):7-23; discussion 23-4. doi: 10.1227/NEU.0000000000000561.
There is limited information on clinical outcomes after anterior lumbar interbody fusion (ALIF) based on the indications for surgery.
To compare the clinical and radiological outcomes of ALIF for each surgical indication.
This prospective clinical study included 125 patients who underwent ALIF over a 2-year period. The patients were evaluated preoperatively and postoperatively. Outcome measures included the Short Form-12, Oswestry Disability Index, Visual Analog Scale, and Patient Satisfaction Index.
After a mean follow-up of 20 months, the clinical condition of the patients was significantly better than their preoperative status across all indications. A total of 108 patients had a Patient Satisfaction Index score of 1 or 2, indicating a successful clinical outcome in 86%. Patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and scoliosis had the best clinical response to ALIF, with statistically significant improvement in the Short Form-12, Oswestry Disability Index, and Visual Analog Scale. Failed posterior fusion and adjacent segment disease showed statistically significant improvement in all of these clinical outcome scores, although the mean changes in the Short Form-12 Mental Component Summary, Oswestry Disability Index, and Visual Analog Scale (back pain) were lower. The overall radiological fusion rate was 94.4%. Superior radiological outcomes (fusion >90%) were observed in patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and failed posterior fusion, whereas in adjacent segment disease, it was 80%.
ALIF is an effective treatment for degenerative disk disease (with and without radiculopathy) and spondylolisthesis. Although results were promising for scoliosis, failed posterior fusion, and adjacent segment disease, further studies are necessary to establish the effectiveness of ALIF in these conditions.
基于手术适应症，关于腰椎前路椎间融合术（ALIF）后临床结局的信息有限。
比较针对每种手术适应症的ALIF的临床和影像学结局。
这项前瞻性临床研究纳入了在2年期间接受ALIF的125例患者。对患者进行术前和术后评估。结局指标包括简明健康调查简表（Short Form-12）、奥斯威斯功能障碍指数（Oswestry Disability Index）、视觉模拟评分量表（Visual Analog Scale）和患者满意度指数。
平均随访20个月后，所有适应症患者的临床状况均显著优于术前。共有108例患者的患者满意度指数评分为1或2，表明86%的临床结局成功。患有退行性椎间盘疾病（伴或不伴神经根病）、腰椎滑脱和脊柱侧弯的患者对ALIF的临床反应最佳，简明健康调查简表、奥斯威斯功能障碍指数和视觉模拟评分量表均有统计学意义的改善。后路融合失败和相邻节段疾病在所有这些临床结局评分上均有统计学意义的改善，尽管简明健康调查简表心理成分汇总、奥斯威斯功能障碍指数和视觉模拟评分量表（背痛）的平均变化较低。总体影像学融合率为94.4%。在患有退行性椎间盘疾病（伴或不伴神经根病）、腰椎滑脱和后路融合失败的患者中观察到较好的影像学结局（融合>90%），而在相邻节段疾病中为80%。
ALIF是治疗退行性椎间盘疾病（伴或不伴神经根病）和腰椎滑脱的有效方法。尽管对于脊柱侧弯、后路融合失败和相邻节段疾病的结果很有前景，但仍需要进一步研究以确定ALIF在这些情况下的有效性。
