title: Stand-alone anterior lumbar interbody fusion for treatment of degenerative spondylolisthesis.
abstract: We sought to evaluate the clinical and radiologic efficacy of stand-alone anterior lumbar interbody fusion (ALIF) for low grade degenerative spondylolisthesis, the favoured surgical management approach at our institution. The optimal approach for surgical management of spondylolisthesis remains contentious. We performed a prospective analysis of all consecutive patients with low grade lumbar spondylolisthesis who underwent ALIF between 2009 and 2013 by a single surgeon (n=27). The mean age was 64.9 years with a male to female ratio of 14:13. There were 32 levels operated and the average preoperative spondylolisthesis was 14.8%, which reduced to 6.4% postoperatively and 9.4% at the latest follow-up (p=0001). Postoperative disc height was increased to 175% of preoperative values and was statistically significant (p<0.001) and remained improved with an overall change of 139% at the latest follow-up. The radiological fusion rate was 91%. The 12-Item Short Form Health Survey (SF-12) mental and physical component summary improved from 31.7 to 43.0 (p=0.007) and from 35.4 to 51.7 (p=0.0026), respectively. The mean visual analogue scale pain score improved from 7.6 to 2.2 (p<0.001), and the mean Oswestry disability index improved from 56.9 to 17.8% (p<0.0001). The overall clinical success rate was 93%. The posterior disc height correlated with spondylolisthesis reduction (p=0.04) and the only clinical factor affecting reduction was body mass index (p=0.04). The present study provides encouraging short term results for stand-alone ALIF as a procedure for low grade lumbar degenerative spondylolisthesis. Future studies should include adequately powered, prospective, multicentre registry studies with long term follow-up to allow a better assessment of the relative benefits and risks.
authors.affiliation: Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia. Electronic address: prashanthdr@gmail.com.
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
authors.affiliation: Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Finn
authors.initials: F
authors.lastname: Ghent
authors.affiliation: Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Keegan
authors.initials: K
authors.lastname: Lee
authors.affiliation: Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Reddy
authors.affiliation: Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior lumbar interbody fusion; Degenerative; Low grade; Spondylolisthesis