Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA.
Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
Spine J. 2019 Jul;19(7):1294-1301. doi: 10.1016/j.spinee.2019.03.001. Epub 2019 Mar 11.
Anterior lumbar interbody fusion (ALIF) has been used for treatment of a variety of spinal conditions including degenerative disc disorders and low-grade spondylolisthesis. Expected fusion rate of stand-alone ALIF constructs is currently unclear. The aim of this study was to examine the fusion rate for ALIF without supplemental posterior fusion or instrumentation (stand-alone ALIF).
We queried the MEDLINE, COCHRANE, and EMBASE databases for all literature related to spine fusion rates using a stand-alone ALIF procedure with a publication cutoff date of July 19, 2018. Supplementary combinations of search terms included spine, fusion, fixation, rate(s), and arthrodesis. ALIF surgery was considered stand-alone when not paired with supplemental posterior fusion or posterior spinal instrumentation. Nonhuman and non-English publications were excluded. Cohort fusion rate differences were calculated using Student t test with significance assigned if p value was less than .05.
Title and abstract level review required assessing 840 unique publications. Across the 55 studies that met the inclusion criteria of this systematic review, 5,517 patients and 6,303 vertebral levels were fused. The overall weighted average patient fusion rate following stand-alone ALIF was 88.2% (range: 16.6%-100%). In the 31 studies with at least 50 subjects, the weighted average fusion rate following stand-alone ALIF was 88.6% (range: 57.5%-99.0%). Use of anterior fixation plate devices yielded a fusion rate of 94.2%. Newer zero-profile interbody implants had a fusion rate of 89.2%. Fusion rates were lower in studies with 50% or more subjects having positive smoking and worker's compensation status, however these results were found to be statistically insignificant (p>.05). Fusion rate for subjects in the eight rhBMP-2 study groups was 94.4% (n=889) compared with 84.8% (n=3,102) in 38 study groups without rhBMP-2 used.
Based on the available data, stand-alone ALIF procedures yield high fusion rates overall. Fusion failure and pseudoarthrosis rates are higher in study populations involving a high percentage of smokers or positive workers compensation status. Allograft utilization does not significantly improve fusion rate when compared with autograft in stand-alone ALIF constructs.
前路腰椎间融合术（ALIF）已被用于治疗多种脊柱疾病，包括退行性椎间盘疾病和低度脊椎滑脱。目前尚不清楚单纯 ALIF 结构的预期融合率。本研究的目的是检查无辅助后路融合或内固定（单纯 ALIF）的 ALIF 融合率。
我们在 MEDLINE、COCHRANE 和 EMBASE 数据库中查询了所有与使用单纯 ALIF 手术治疗脊柱融合率相关的文献，截止日期为 2018 年 7 月 19 日。搜索词的补充组合包括脊柱、融合、固定、率和融合术。当单纯 ALIF 手术未与辅助后路融合或后路脊柱内固定联合使用时，即被认为是单纯手术。排除非人类和非英语出版物。使用 Student t 检验计算融合率差异，p 值小于 0.05 则认为具有统计学意义。
标题和摘要水平的审查需要评估 840 篇独特的出版物。在符合本系统评价纳入标准的 55 项研究中，5517 名患者和 6303 个椎体水平进行了融合。单纯 ALIF 术后的总体加权平均患者融合率为 88.2%（范围：16.6%-100%）。在至少有 50 名受试者的 31 项研究中，单纯 ALIF 术后的加权平均融合率为 88.6%（范围：57.5%-99.0%）。使用前路固定板装置的融合率为 94.2%。新型零轮廓椎间植入物的融合率为 89.2%。在 50%以上受试者有吸烟和工人赔偿状态阳性的研究中，融合率较低，但这些结果无统计学意义（p>.05）。在 8 个 rhBMP-2 研究组的受试者中，融合率为 94.4%（n=889），而在 38 个未使用 rhBMP-2 的研究组中，融合率为 84.8%（n=3102）。
根据现有数据，单纯 ALIF 手术总体上具有较高的融合率。在涉及大量吸烟者或工人赔偿状态阳性的研究人群中，融合失败和假关节形成率较高。在单纯 ALIF 结构中，同种异体移植物的使用并不能显著提高融合率，与自体移植物相比。
