Comparative analysis of anterior lumbar interbody fusion and transforaminal lumbar interbody fusion in clinical outcomes: ALIF associated with lower rates of adjacent segment degeneration (ASD) in a long-term follow-up study.

PURPOSE

To compare the long-term efficacy of anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) in treating lumbar degenerative diseases.

METHODS

A retrospective analysis was conducted on 57 patients with lumbar degenerative diseases who underwent either ALIF or TLIF from March 2003 to October 2007. Patients were divided into an ALIF group (n = 27) and a TLIF group (n = 30). Pain was evaluated using the visual analogue scale (VAS), and the Oswestry Disability Index (ODI) was used to assess clinical outcomes. Radiographic adjacent segment degeneration (rASD) was evaluated using the Modified Pfirrmann Scale. Three-dimensional CT was used to assess the fusion rate at the last follow-up.

RESULTS

Follow-up duration ranged from 58 to 120 months, with an average of 90.6 months. No significant difference was observed in VAS and ODI scores between the two groups (P > 0.05). However, significant differences were noted before and after the operation (P < 0.05). The intervertebral disc height (IDH) and lumbar lordosis (LL) increased after the operation and during follow-ups. The IDH and LL in the ALIF group were significantly higher than those in the TLIF group both postoperatively and at follow-ups (P < 0.05). At the last follow-up, the incidence of rASD in the ALIF group was significantly lower than in the TLIF group (P < 0.05).

CONCLUSIONS

Both ALIF and TLIF provide satisfactory long-term outcomes for lumbar degenerative diseases. ALIF more effectively restores and maintains lumbar intervertebral height and lumbar lordosis, potentially reducing the incidence of adjacent segment degeneration.