与L4-S1经椎间孔腰椎椎体间融合术相比，L4-S1前路腰椎椎体间融合术可恢复并维持脊柱前凸，同时将相邻节段疾病的发生降至最低。

L4-S1 ALIF restores and maintains lordosis while minimizing adjacent segment disease compared to L4-S1 TLIF.

作者信息

Zhang Yi, Vengsarkar Ved A, Chi Jialun, Yang Hanzhi, Goudarzi Ariaz, Shen Mia, Jin Li, Cho Samuel K, Yoon S Tim, Li Xudong

机构信息

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA; Department of Spine Surgery, Spinal Deformity Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA; Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA.

出版信息

Spine J. 2025 Jun 4. doi: 10.1016/j.spinee.2025.06.001.

DOI:10.1016/j.spinee.2025.06.001

PMID:40480521

Abstract

BACKGROUND CONTEXT

The L4-S1 region contributes the most to lumbar lordosis, and adjacent segment disease (ASD) is a common complication following lumbar interbody fusion. To date, no study has directly compared sagittal alignment parameters and incidence of ASD between ALIF and TLIF for the treatment of L4-S1 degenerative disc disease.

PURPOSE

This study aims to evaluate and compare the efficacy of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) in restoring L4-S1 lordosis and the impact on the development of ASD.

STUDY DESIGN

A retrospective cohort study.

PATIENT SAMPLE

102 TLIF patients and 53 ALIF patients were identified from a single-center database.

OUTCOME MEASURES

Complications, revisions, and radiological sagittal parameters.

METHODS

We conducted a retrospective study involving patients who underwent L4-S1 fusion for degenerative lumbar disease from January 2017 to December 2021. Patients were categorized into TLIF and ALIF groups, with demographic, surgical, and radiographic data collected. Radiographic parameters were assessed preoperatively, postoperatively, and at final follow-up (45.8 ± 13.2 months).

RESULTS

A total of 155 patients were analyzed (102 TLIFs and 53 ALIFs). Both groups exhibited significant changes in L4-S1 lordosis postoperatively; however, ALIF resulted in a more pronounced increase in L4-S1 lordosis (6.5° vs. 1.3°) and reduced compensatory changes at L3/4 compared with TLIF (-2.4° vs. 0.2°). ALIF also maintained 72% of the lordosis restoration over time. Moreover, ALIF had lower incidences of ASD (3.8% vs. 15.7%, p=.034) and significantly fewer reoperations (7.5% vs. 25.5%, p=.009). A binary logistic regression analysis revealed that an increase in postoperative L4-S1 lordosis (OR 0.903 [95% CI: 0.820-0.994]) and a decrease in delta L3/4 (OR 0.757 [95% CI: 0.597-0.961]) were significantly associated with the reduced risk of ASD.

CONCLUSIONS

ALIF demonstrated superior effectiveness compared to TLIF in restoring and maintaining L4-S1 lordosis, mitigating compensatory lordosis, and decreasing the incidence of ASD.

LEVEL OF EVIDENCE

III.

摘要

背景

L4-S1节段对腰椎前凸的贡献最大，相邻节段疾病（ASD）是腰椎椎间融合术后的常见并发症。迄今为止，尚无研究直接比较前路腰椎椎间融合术（ALIF）和经椎间孔腰椎椎间融合术（TLIF）治疗L4-S1退变性椎间盘疾病时的矢状位对线参数和ASD发生率。

目的

本研究旨在评估和比较前路腰椎椎间融合术（ALIF）与经椎间孔腰椎椎间融合术（TLIF）在恢复L4-S1前凸方面的疗效以及对ASD发生发展的影响。

研究设计

一项回顾性队列研究。

患者样本

从单中心数据库中确定了102例TLIF患者和53例ALIF患者。

观察指标

并发症、翻修情况和放射学矢状位参数。

方法

我们进行了一项回顾性研究，纳入了2017年1月至2021年12月因退变性腰椎疾病接受L4-S1融合术的患者。将患者分为TLIF组和ALIF组，收集人口统计学、手术和影像学数据。在术前、术后及末次随访（45.8±13.2个月）时评估影像学参数。

结果

共分析了155例患者（102例TLIF和53例ALIF）。两组术后L4-S1前凸均有显著变化；然而，与TLIF相比，ALIF导致L4-S1前凸增加更明显（6.5°对1.3°），L3/4节段的代偿性变化减少（-2.4°对0.2°）。随着时间推移，ALIF还维持了72%的前凸恢复。此外，ALIF的ASD发生率较低（3.8%对15.7%，p=0.034），再次手术明显更少（7.5%对25.5%，p=0.009）。二元逻辑回归分析显示，术后L4-S1前凸增加（OR 0.903[95%CI：0.820-0.994]）和L3/4节段变化值减小（OR 0.757[95%CI：0.597-0.961]）与ASD风险降低显著相关。