Comparison of the Safety Outcomes between Anterior Lumbar Interbody Fusion and Extreme Lateral Interbody Fusion. (May 2014)

• Record Type: Journal Article
• Authors: Hartl, R.; Christensen, F.; Korge, A.; Lam, K.; Vialle, E.; Zigler, J.; McGuire, R.
• Is Part Of: Global spine journal. Volume 4:Number 1(2014)Supplement
• Page Start: s-0034-1376735
• Page End: s-0034-1376735
• Publication Date: 2014-05
• Subjects: Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1055/s-0034-1376735
• Languages: English
• ISSNs: 2192-5682

Abstract

Introduction: This review compares the safety of the interbody fusion procedures anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders. ALIF is well established whereas ELIF is a novel procedure. Materials and Methods: We performed a systematic literature search in the databases Cochrane (CENTRAL), MEDLINE, EMBASE, and the FDA register. Information was collected on study design, sample size, population, procedure, indication incl. number, and location of levels involved, follow-up (FU) time and adverse events. Moreover, information on conflict of interest and source of funding was captured. Results: Of 32 eligible publications, 22 dealt with ELIF, 9 with ALIF, and 1 compared ELIF with ALIF. All of the ELIF studies were case series. The number of patients was 2, 165 and 1, 379, with a FU time from 45 days to 24 months and 24 months to 5 years for ELIF and ALIF, respectively. The risk to experience certain types of adverse events (e.g., reoperations, hardware failures, DVT, and cardiac) appeared significantly lower for patients undergoing ELIF. Pseudarthrosis was seen in 0.14 and 1.02% of ELIF and ALIF cases, respectively. Neurological complications occurred in 7.62% of ELIF and 9.43% of ALIF cases. Category of adverse event ELIF ( N = 2, 165), % (95% CI) ALIF ( N = 379), % (95% CI) Risk ratio (95% CI) p Value Neurologic AEs (transient motor weakness, transient hypoesthesia, transient thigh symptoms) 7.62 (6.58-8.82) 9.43 (7.992-11.09) 0.79 (0.6234-1.009) 0.059 Pseudarthrosis 0.14 (0.02665-0.4271) 1.02 (0.5891-1.714) 0.1354 (0.03106-0.4379) 0.000 Hardware failure (subsidence of cage, intraoperative pedicle fracture, implant bone interface failure, and cage breakage) 1.39 (0.965-1.979) 3.41 (2.564-4.511) 0.40 (0.2484-0.6315) 0.000 Secondary surgical procedure (revisions, supplemental fixations, and reoperations) 1.85 (1.353-2.512) 8.77 (7.389-10.39) 0.1958 (0.1348-0.2801) < 0.0001 Conclusion: ELIF procedures demonstrated a favorable safety outcome compared with ALIF, nonetheless the lack of comparative studies, length of follow-up, and low level of evidence is a limitation of this review. Disclosure of Interest R. Hartl: Conflict with DePuy Synthes, Spine Wave, Brainlab, Lanx F. Christensen: None declared A. Korge: None declared K. Lam: None declared E. Vialle: None declared J. Zigler: None declared R. McGuire: None declared