Skip to main content
Log in

Standardized evaluation of long-term results after anterior lumbar interbody fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

A total of 113 patients, excluding those with tumor, spondylitis, and idiopathic scoliosis, underwent anterior lumbar interbody fusion (ALIF) with autologous iliac crest graft between 1984 and 1991 at our department. The proportion of these who were failed back patients was higher than that reported in the literature. Evaluation of functional outcome was feasible in 80 patients, utilizing Oswestry and Marburg scores, which were closely intercorrelated. The overall results yielded an improvement in the Oswestry score of 35.7 percentage points. A subset of 52 patients who were evaluated twice, showed the same results at an average of 6.6 years as they did at 2.3 years following surgery. Functional results showed a weak correlation with postoperative height loss of the intervertebral space. Influencing factors for the functional result were: postoperative compensation claim, age, and obesity. Of the professional people involved, 19.4% did not return to any occupation. Patients satisfied with the result had significantly greater functional improvement. Younger patients with additional dorsal distraction prior to ALIF for reduction of severe spondylolisthesis fared better than patients with ALIF alone. The rate of complications was low and did not contribute to the postoperative functional result. On the basis of these results further prospective studies have been designed and are currently underway.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Akkerveken PF v. (1993) Anterior lumbar interbody fusion. Acta Orthop Scand [Suppl] 251:105–107

    Google Scholar 

  2. Beurskens AJ, Vet HC de, Köke AJ, Heijden GJ van der, Knipschild PG (1995) Measuring the functional status of patients with low back pain. Spine 9:1017–1028

    Google Scholar 

  3. Blumenthal SL, Gill K (1993) Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions. Spine 18:1186–1189

    Google Scholar 

  4. Bogdanffy GM, Ohnmeiss DD, Guyer RD (1994) Early changes in bone mineral density above a combined anterior-posterior L4–S1 lumbar spine fusion in-vivo (abstract). Transactions of the 40th Annual Meeting of the Orthopaedic Research Society, New Orleans 19:704

    Google Scholar 

  5. Burns BH (1933) An operation for spondylolisthesis. Lancet I:1233

    Google Scholar 

  6. Capener N (1932) Spondylolisthesis. Br J Surg 19:374

    Google Scholar 

  7. Christensen FB, Nielsen BK, Hansen ES, Pilgaard S, Bunger CE (1994) Anterior lumbar intercorporal spondylodesis. Radiological and functional therapeutic results. Ugeskr Laeger 156: 5285–5289

    Google Scholar 

  8. Deyo RA, Andersson G, Bombardier C, Cherkin DC, Keller RB, Lee CK, Liang MH, Lipscomb B, Shekelle P, Spratt KF, Weinstein JN (1994) Outcome measures for studying patients with low back pain. Spine [Suppl] 18: 2032–2036

    Google Scholar 

  9. Fairbank JCT, Couper J, Davies JB, O'Brien J (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    Google Scholar 

  10. Flynn JC, Hoque A (1979) Anterior fusion of the lumbar spine. J Bone Joint Surg [Am] 61:1143–1150

    Google Scholar 

  11. Fraser RD (1982) A wide muscle-splitting approach to the jumbosacral spine. J Bone Joint Surg [Br] 64:44

    Google Scholar 

  12. Greenough CG, Taylor LJ, Fraser RD (1994) Anterior lumbar fusion: results, assessment techniques and prognostic factors. Eur Spine J 3:225–230

    Google Scholar 

  13. Griss P (1990) Der Kreuzschmerz-Operative Therapie. In: Springorum HW, Katthagen BD (eds) Aktuelle Schwerpunkte der Orthopädie. Thieme, Stuttgart, pp 37–44

    Google Scholar 

  14. Griss P, Harms J, Zielke K (1984) Anterior instrumentation and fusion. In: Dickson RA, Bradford DS (eds) Management of spinal deformities. Butterworths, London Boston Durban, pp 193–235

    Google Scholar 

  15. Hanley ENJ, Levy JA (1989) Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results. Spine 1:48–50

    Google Scholar 

  16. Harmon PD (1960) Anterior extraperitoneal lumbar disc excision and vertebral body fusion. Clin Orthop 18:169

    Google Scholar 

  17. Harrington PR, Tullos HS (1969) Reduction of severe spondylolisthesis in children. South Med J 62:1–7

    Google Scholar 

  18. Hazard RG, Haugh LD, Green PA, Jones PL (1994) Chronic low back pain — the relationship between patient satisfaction and pain, impairment, and disability outcomes. Spine 8:881–887

    Google Scholar 

  19. Holte DC, O'Brien JP, Renton P (1994) Anterior lumbar fusion using a hybrid interbody graft. A preliminary radiographic report. Eur Spine J 3:32–38

    Google Scholar 

  20. Iwahara T (1944) A new method of vertebral body fusion. Surgery 271:8

    Google Scholar 

  21. Kausch W (1910) Die Resektion der Lendenwirbelkörper. Dtsch Z Chir 106:346–368

    Google Scholar 

  22. Knox BD, Chapman TM (1993) Anterior lumbar interbody fusion for discogram concordant pain. J Spinal Disord 6:242–244

    Google Scholar 

  23. Knutsson F (1944) The instability associated with disk degeneration in the lumbar spine. Acta Radiol 25:593–609

    Google Scholar 

  24. Kopec JA, Esdaile JM (1995) Spine update — Functional disability scales for back pain. Spine 20:1943–1949

    Google Scholar 

  25. Kozak JA, Heilman AE, O'Brien JP (1994) Anterior lumbar fusion options. Technique and graft materials. Clin Orthop 294:45–51

    Google Scholar 

  26. Little DG, MacDonald D (1994) The use of the percentage change in Oswestry Disability Index Score as an outcome measure in lumbar spinal surgery. Spine 19:2139–2143

    Google Scholar 

  27. Matzen KA (1989) Die ventrale interligamentäre-interkorporelle Spondylodese bei der Spondylolisthesis. Z Orthop Ihre Grenzgeb 127:39–46

    Google Scholar 

  28. Moon MS, Kim SS, Sun DH, Moon YW (1994) Anterior spondylodesis for spondylolisthesis: isthmic and degenerative types. Eur Spine J 3:172–176

    Google Scholar 

  29. Müller F (1906) Transperitoneale Freilegung der Wirbelsäule bei tuberkulöser Spondylitis. Dtsch Z Chir 85:128

    Google Scholar 

  30. O'Brien JP (1983) The role of fusion for chronic low back pain. Orthop Clin North Am 14:639–647

    Google Scholar 

  31. Putto E, Tallroth K (1994) Extension-flexion radiographs for motion studies of the lumbar spine — a comparison of two methods. Spine 15:102–107

    Google Scholar 

  32. Ruta DA, Garatt AM, Wardlaw D, Russell IT (1994) Developing a valid and reliable measure of health outcome for patients with low back pain. Spine 17:1887–1896

    Google Scholar 

  33. Soini J (1994) Lumbar disc space heights after external fixation and anterior interbody fusion. J Spinal Disord 7:487–494

    Google Scholar 

  34. Stauffer RN, Coventry MB (1972) Anterior interbody lumbar spine fusion —analysis of Mayo Clinic series. J Bone Joint Surg [Am] 54:756–768

    Google Scholar 

  35. Streiner GL, Norman DR (1990) Health measurement scales: practical guide to their development and use. Oxford University Press, Oxford

    Google Scholar 

  36. Takahashi K, Kitahara H, Yamagata M, Murakami M, Takata K, Miyamoto K, Mimura M, Akahashi Y, Moriya H (1990) Long-term results of anterior interbody fusion for treatment of degenerative spondylolisthesis. Spine 15:121

    Google Scholar 

  37. Triano JJ, McGregor M, Cramer GD, Emde D (1993) A comparison of outcome measures for use with back pain patients. J Manipulative Physiol Ther 16:67–73

    Google Scholar 

  38. Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, Deyo R (1992) Patient outcomes after lumbar spinal fusions. JAMA 7:907–911

    Google Scholar 

  39. Turner JA, Herron L, Deyo RA (1993) Meta-analysis of the results of lumbar spine fusion. Acta Orthop Scand [Suppl] 251:120–122

    Google Scholar 

  40. Waddell G (1993) Evaluation of results in lumbar spine surgery. Clinical outcome measures — assessment of severity. Acta Orthop Scand [Suppl] 251: 134–137

    Google Scholar 

  41. Watkins R (1992) Anterior lumbar interbody fusion surgical complications. Clin Orthop 47–53

  42. Willner S (1993) Lumbar spine fusion — conclusions. Acta Orthop Scand [Suppl] 251:123–124

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pfeiffer, M., Griss, P., Haake, M. et al. Standardized evaluation of long-term results after anterior lumbar interbody fusion. Eur Spine J 5, 299–307 (1996). https://doi.org/10.1007/BF00304344

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00304344

Key words

Navigation