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)
- 1.7k Downloads
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.
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.
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).
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.
KeywordsExtreme lateral interbody fusion (ELIF) Extreme lateral interbody fusion (XLIF) Anterior lumbar interbody fusion (ALIF) Lumbar fusion surgery Degenerative disc disease (DDD)
The presented meta-analysis was performed with the support of the AO Foundation via the AOSpine TK Grant.
Compliance with ethical standards
Conflict of interest
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.
- 3.Harms JG, Jeszenszky D (1998) The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–99Google Scholar
- 10.Pimenta L (2001) Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery. In: VIII Brazilian Spine Society Meeting. Belo Horizonte, Minas Gerais, BrazilGoogle Scholar
- 11.Pimenta L (2010) The use of rh-BMP2 in standalone eXtreme Lateral Interbody Fusion (XLIF®): clinical and radiological results after 24 months follow-up. World Spinal Column J 1:19–25Google Scholar
- 13.Rodgers WB, Cox CS, Gerber EJ (2007) Experience and early results with a minimally invasive technique for anterior column support through extreme lateral interbody fusion (XLIF®). US Musculoskelet Rev 1:28–32Google Scholar
- 26.Karikari IO, Grossi PM, Nimjee SM, Hardin C, Hodges TR, Hughes BD, Brown CR, Isaacs RE (2011) Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications. Neurosurgery 68:897–902. doi: 10.1227/NEU.0b013e3182098bfa (discussion 902) CrossRefPubMedGoogle Scholar
- 33.Rodgers WB, Cox CS, Gerber EJ (2009) Minimally invasive treatment (XLIF) of adjacent segment disease after prior lumbar fusions. Int J Minim Invasive Spinal Technol 3:1–7Google Scholar
- 40.Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, Garcia R Jr, Regan JJ, Ohnmeiss DD (2005) A prospective, randomized, multicenter food and drug administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine (Phila Pa 1976) 30:1565–1575 (discussion E1387-1591) CrossRefGoogle Scholar
- 41.Food and Drug Administration (2004) CHARITÉ™ Artificial Disc-P040006; Summary of safety and effectiveness data. http://www.accessdata.fda.gov/cdrh_docs/pdf4/p040006a.pdf. Accessed Mar 2015
- 42.Guyer RD, McAfee PC, Banco RJ, Bitan FD, Cappuccino A, Geisler FH, Hochschuler SH, Holt RT, Jenis LG, Majd ME, Regan JJ, Tromanhauser SG, Wong DC, Blumenthal SL (2009) Prospective, randomized, multicenter food and drug administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: five-year follow-up. Spine J 9:374–386. doi: 10.1016/j.spinee.2008.08.007 CrossRefPubMedGoogle Scholar
- 43.Li J, Dumonski ML, Liu Q, Lipman A, Hong J, Yang N, Jin Z, Ren Y, Limthongkul W, Bessey JT, Thalgott J, Gebauer G, Albert TJ, Vaccaro AR (2010) A multicenter study to evaluate the safety and efficacy of a stand-alone anterior carbon I/F Cage for anterior lumbar interbody fusion: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 35:E1564–E1570. doi: 10.1097/BRS.0b013e3181ef5c14 CrossRefGoogle Scholar
- 44.Zigler J, Delamarter R, Spivak JM, Linovitz RJ, Danielson GO 3rd, Haider TT, Cammisa F, Zuchermann J, Balderston R, Kitchel S, Foley K, Watkins R, Bradford D, Yue J, Yuan H, Herkowitz H, Geiger D, Bendo J, Peppers T, Sachs B, Girardi F, Kropf M, Goldstein J (2007) Results of the prospective, randomized, multicenter food and drug administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine (Phila Pa 1976) 32:1155–1162. doi: 10.1097/BRS.0b013e318054e377 (discussion 1163) CrossRefGoogle Scholar
- 45.Delamarter R, Zigler JE, Balderston RA, Cammisa FP, Goldstein JA, Spivak JM (2011) Prospective, randomized, multicenter food and drug administration investigational device exemption study of the ProDisc-L total disc replacement compared with circumferential arthrodesis for the treatment of two-level lumbar degenerative disc disease: results at twenty-four months. J Bone Joint Surg Am 93:705–715. doi: 10.2106/jbjs.i.00680 CrossRefPubMedGoogle Scholar
- 46.Food and Drug Administration (2006) PRODISC®-L Total Disc Replacement P050010: Summary of safety and effectiveness data. http://www.accessdata.fda.gov/cdrh_docs/pdf5/p050010a.pdf. Accessed Mar 2015
- 47.Food and Drug Administration (1999) INTER FIX Threaded Fusion Device P970015: Summary of safety and effectiveness dataGoogle Scholar
- 48.Food and Drug Administration (2002) InFUSE™ Bone Graft/LT-CAGE™ Lumbar Tapered Fusion Device P000058: Summary of safety and effectiveness data;. http://www.accessdata.fda.gov/cdrh_docs/pdf/P000058a.pdf. Accessed Mar 2015
- 51.Geisler FH, Blumenthal SL, Guyer RD, McAfee PC, Regan JJ, Johnson JP, Mullin B (2004) Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charite intervertebral disc. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:143–154. doi: 10.3171/spi.2004.1.2.0143 CrossRefPubMedGoogle Scholar