Our Summary

This research paper is a comparison study between two types of lower back surgery treatments - anterior interbody lumbar fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF). The study included 70 patients who had either ALIF or TLIF treatments between 2011 and 2020, and they were monitored for at least 12 months after their surgery.

The research was looking at two main outcomes: radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP). These are medical terms for issues that can occur in the sections of the spine next to where the surgery was performed.

The study found that, after a single-level fusion surgery in the lower back, ALIF treatment was better than TLIF at maintaining the natural curve of the lower spine. However, patients who had the ALIF treatment had a significantly higher chance of instability in the sections of the spine next to where the surgery was performed.

In terms of the overall occurrence of RASP and CASP, there was no significant difference between the ALIF and TLIF treatments.

FAQs

  1. What is the difference between anterior interbody lumbar fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF)?
  2. What are the risks and benefits associated with ALIF and TLIF treatments?
  3. Did the study find any significant difference in the incidence of adjacent segment pathology (ASP) between ALIF and TLIF treatments?

Doctor’s Tip

A doctor might advise a patient undergoing lumbar fusion surgery to maintain a healthy weight, avoid smoking, and follow a proper exercise regimen to help reduce the risk of adjacent segment pathology in the future. Additionally, regular follow-up appointments and imaging studies may be recommended to monitor the health of the adjacent spinal segments.

Suitable For

Patients who are typically recommended lumbar fusion surgery include those with:

  1. Degenerative disc disease
  2. Spinal stenosis
  3. Spondylolisthesis
  4. Herniated discs
  5. Failed back surgery syndrome
  6. Instability in the lumbar spine
  7. Chronic low back pain that has not responded to conservative treatments.

Timeline

  • Before lumbar fusion: The patient may have been experiencing chronic back pain, leg pain, or other symptoms related to a degenerative spinal condition. They may have tried conservative treatments such as physical therapy, medications, or injections without relief. After consulting with a spine surgeon, the decision is made to undergo lumbar fusion surgery.

  • During lumbar fusion surgery: The patient is placed under general anesthesia, and the surgeon makes an incision in the lower back to access the spine. The damaged disc or vertebrae are removed, and bone graft material is inserted to promote fusion. Hardware such as screws and rods may be used to stabilize the spine during healing.

  • After lumbar fusion surgery: The patient will typically stay in the hospital for a few days for monitoring and pain management. They will gradually start physical therapy to regain strength and mobility. The recovery process can take several weeks to months, depending on the individual and the extent of the surgery. Follow-up appointments with the surgeon will be scheduled to monitor healing and address any concerns.

  • Long-term outcomes: In the years following lumbar fusion, the patient may experience relief from their previous symptoms and improved quality of life. However, there is a risk of developing adjacent segment pathology (ASP), where the discs above or below the fusion site degenerate and cause new symptoms. Regular follow-up appointments and imaging studies may be recommended to monitor for ASP and other potential complications.

What to Ask Your Doctor

  1. What is the success rate of lumbar fusion surgery in terms of relieving pain and improving function?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. How long is the recovery period after lumbar fusion surgery and what can I expect during this time?
  4. Will I need physical therapy or rehabilitation after lumbar fusion surgery?
  5. What activities should I avoid after lumbar fusion surgery to prevent complications?
  6. How long do the results of lumbar fusion surgery typically last?
  7. What is the likelihood of developing adjacent segment pathology (ASP) after lumbar fusion surgery?
  8. How can I reduce my risk of developing ASP after lumbar fusion surgery?
  9. What are the symptoms of ASP and when should I seek medical attention if I experience them?
  10. Are there any alternative treatments to lumbar fusion surgery that I should consider?

Reference

Authors: Wu PK, Wu MH, Shih CM, Lin YK, Chen KH, Pan CC, Huang TJ, Lee CY, Lee CH. Journal: Tomography. 2021 Dec 2;7(4):855-865. doi: 10.3390/tomography7040072. PMID: 34941644