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Comparison of the safety outcomes between two surgical approaches for anterior lumbar fusion surgery: anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (ELIF)

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Abstract

Purpose

To review the evidence on safety of anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders with an emphasis on the association between neuromonitoring and complications.

Methods

We performed a systematic literature search in the Cochrane (CENTRAL), MEDLINE, EMBASE and the FDA Medical Devices databases. We abstracted information on study design, sample size, population, procedure, number and location of involved levels, follow-up time and complications, as well as information on conflict of interest and source of funding. In addition, for ELIF we collected information on the use of neuromonitoring during the procedure.

Results

34 publications were included in the review: 24 ELIF (all case series), 9 ALIF (8 randomized controlled trials and 1 case series) and one retrospective cohort that directly compared ELIF with ALIF. 18 out of 24 ELIF studies reported using neuromonitoring. The overall complication rate for ELIF was lower compared to ALIF without FDA reports (16.61 vs. 26.47 %, respectively). However, the rate of neurologic complications in ELIF was almost twice as high compared to ALIF without FDA reports (8.92 and 4.96 %, respectively). The rate of overall complications in ELIF studies that were reported using neuromonitoring was lower compared to the studies that did not report using neuromonitoring (16.34 vs. 21.74 %, respectively).

Conclusion

Although the overall complications rate for ELIF was lower compared to ALIF, ELIF is associated with a greater risk of neurological complications compared to ALIF even when used with neuromonitoring.

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Acknowledgments

The presented meta-analysis was performed with the support of the AO Foundation via the AOSpine TK Grant.

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Authors and Affiliations

  1. Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, 10021, USA

    Roger Härtl

  2. AO Clinical Investigation and Documentation, Dübendorf, Switzerland

    Alexander Joeris

  3. Department of Orthopedics and Rehabilitation, University of Mississippi Medical Center, Jackson, USA

    Robert A. McGuire

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  1. Roger Härtl
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Correspondence to Roger Härtl.

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R. Hartl and R. McGuire do not have a financial relationship with the sponsoring organization and they have full control of all primary data and agree to allow the journal to review the data if requested. A. Joeris is an employee of the AO Foundation but his salary does not depend on the publication of this article nor does he have any other benefits by its publication. A. Joeris has full control of all primary data and also agrees to allow the journal to review the data if requested.

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Härtl, R., Joeris, A. & McGuire, R.A. Comparison of the safety outcomes between two surgical approaches for anterior lumbar fusion surgery: anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (ELIF). Eur Spine J 25, 1484–1521 (2016). https://doi.org/10.1007/s00586-016-4407-6

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  • DOI: https://doi.org/10.1007/s00586-016-4407-6

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