Anterior Lumbar Interbody Fusion (ALIF) Versus Full-Endoscopic/Percutaneous TLIF With a Large-Footprint Interbody Cage: A Comparative Observational Study.

Study Design: Exploratory prospective observational case-control study.

Objectives: Aim of this study was to compare clinical and radiologic outcome, as well as peri-operative complications, of anterior lumbar interbody fusion (ALIF) and full-endoscopic/percutaneous trans-Kambin transforaminal lumbar interbody fusion (pTLIF) with a large-footprint interbody cage.

Methods: Patients that underwent elective ALIF and pTLIF with a large-footprint interbody cage were prospectively evaluated. Clinical follow-up was measured pre- and post-operatively with Visual Analogic Scale and Oswestry Disability Index scores. Radiologic outcome was assessed with a computed tomography scan and standing films at 12 months.

Results: 44 patients underwent ALIF and 43 pTLIF surgery (total 87 cases). Clinical pre- and post-operative scores were comparable between both groups with 33.4 months mean follow-up. Median surgical time was significantly lower for pTLIF (28 minutes) compared to ALIF (72 minutes). Radiologic outcome was favorable for ALIF with a significantly higher increase in segmental lordosis compared to pTLIF. Fusion rates did not significantly differ between both groups. ALIF showed significantly less cage subsidence than pTLIF. Complications included 9 (21%) cases with transitory post-operative radiculitis for ALIF and 12 (28%) for pTLIF; post-operative partial muscle weakness 3(6%) cases for ALIF and 4 (9%) for pTLIF. Two (4%) cases required revision surgery for pTLIF.

Conclusions: ALIF and trans-Kambin pTLIF obtained comparable clinical outcome and fusion rates, while segmental lordosis restoration was favorable for ALIF. pTLIF required less surgery time and presented less intra-operative complications, while ALIF reported lower rates of post-operative subsidence, revision surgery and complications during follow-up.