Anterior lumbar discectomy and fusion: an effective technique in treating lumbar disc herniation-- a retrospective case study.

Objective: Lumbar disc herniation is a syndrome triggered by degenerative changes in the intervertebral disc. Based on the technique of ALIF, combining the concept of Anterior Cervical Discectomy and Fusion (ACDF), we summarized Anterior Lumbar Discectomy Fusion (ALDF) in our previous clinical experience. This study is to explore the clinical efficacy and safety of this method for treating lumbar disc herniation.

Method: We retrospectively analyzed the medical records of 44 patients with L5/S1 lumbar disc herniation treated in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, from December 2020 to April 2023. The Japan orthopaedic association (JOA) scoring system, Oswestry disability index (ODI), and Numerical rating scale (NRS, to evaluate pain) were used to assess patients' clinical symptoms before and after surgery. Radiographic examinations, including X-ray, CT, and MRI, were performed to record preoperative and postoperative imaging indicators, such as surgical segment, intervertebral disc height, and dural sac cross-sectional area. Postoperative follow-up records noted the time of bony fusion and postoperative complications.

Results: All 44 patients successfully completed the ALDF operation. No vascular, ureteral, or abdominal organ damage occurred during the operation. All patients' symptoms were alleviated. Postoperative CT scans revealed a significant improvement in intervertebral disc height (7.32 ± 2.07 mm vs. 12.15 ± 1.79 mm, p < 0.05). Postoperative MRI scans showed a significant increase in the cross-sectional area of the dural sac (0.95 ± 0.33cm vs. 1.30 ± 0.37cm, p < 0.05). X-ray re-examination 6 months after surgery showed bony fusion in all operated segments. 12 months postoperatively, the average JOA was 25.57 ± 2.29, ODI was 4.45 ± 3.43%, and NRS was 1.43 ± 1.13, all significantly improved compared to preoperative levels, p < 0.05. There were no complications such as implant failure, cage subsidence, or wound infection.

Conclusion: ALDF provides an effective treatment strategy for patients with lumbar disc herniation. This procedure allows direct removal of protruding discs and calcified posterior longitudinal ligaments under the microscope, achieving the goal of direct decompression of the surgical segment. At the same time, it can reduce the damage to posterior muscles and skeletal structures caused by surgery. Comprehensive preoperative assessment and meticulous microscopic operation can help avoid complications such as nerve and vascular injuries.