Abstract
Objective This was a prospective controlled study with lumbar degenerative disc disease patients
submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior
stabilization.
Methods A sample with 64 consecutive patients was operated by the same surgeons over 4 years.
Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody
cages with integrated screws, filled with bone matrix and bone morphogenetic protein
2, were used.
Results Half of the patients had undergone previous lumbar spine surgeries, 75% presented
with associated degenerative listhesis, and 62.5% had posterior lumbar compression
disease. Approximately 56% of the sample had at least 1 risk factor for nonunion.
The Oswestry index changed from 71.81 ± 7.22 at the preoperative assessment to 24.75 ± 7.82
at the final follow-up evaluation, while the visual analogue pain scale changed from
7.88 ± 0.70 to 2.44 ± 0.87 (p < 0.001). Clinical and functional improvements increased with the number of operated
levels, proving the efficacy of multilevel ALIF, performed in 93.75% of the sample.
The global complication rate was of 7.82%, with no major complications. No cases of
nonunion were observed.
Conclusion Instrumented ALIF combined with posterior stabilization is a successful option for
uni- and multilevel degenerative disc disease of the L3 to S1 segments, even in the
significant presence of risk factors for nonunion and of previous lumbar surgeries,
assuring very satisfactory clinical-functional and radiographic outcomes with a low
medium-term complication rate.
Keywords lumbar vertebrae/surgery - spinal fusion - prospective studies - scoliosis/surgery
- risk factors
