Which Approach Is Advantageous to Preventing Development of Adjacent Segment Disease? Comparative Analysis of 3 Different Lumbar Interbody Fusion Techniques (ALIF, LLIF, and PLIF) in L4-5 Spondylolisthesis

OBJECTIVE: The purpose of this study was to compare radiologic and clinical outcomes in patients with L4-5 lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), or posterior lumbar interbody fusion (PLIF), especially with regard to the development of adjacent segment disease (ASD). METHODS: Eighty-two patients with preoperative L4-5 spondylolisthesis and minimal ASD who underwent instrumented L4-5 fusion were divided into 3 groups according to the surgical approach used for treatment (ALIF: 27 patients, LLIF: 24 patients, PLIF: 31 patients). Radiographic measurements including preoperative and postoperative foraminal and disk height, segmental and lumbar lordosis, percentage of vertebral slippage, and reduction rate were reviewed. The incidence of ASD and clinical outcomes were evaluated and compared between the 3 groups. RESULTS: ASD was found in 37.0% (10/27), 41.7% (10/24), and 64.5% (20/31) of the patients in the ALIF, LLIF, and PLIF groups, respectively (mean follow-up duration: 35.42 +/- 9.35 months). The ALIF and LLIF groups had significantly increased disk and foraminal height compared with the PLIF group. The ALIF group had significantly improved lordosis compared with the PLIF and LLIF groups. There were no statistically significant intergroup differences in clinical outcomes assessed by visual analog scale and Oswestry Disability Index. CONCLUSION: The 3 different fusion techniques investigated can all produce good outcomes in treating lumbar spondylolisthesis in L4-5, but ALIF and LLIF are more advantageous in preventing the development of ASD.