Standalone Anterior Lumbar Interbody Fusion (sa-ALIF) Versus Transforaminal Lumbar Interbody Fusion (TLIF) in the Management of Lumbar Degenerative Disc Diseases

Background: The majority of patients with lumbar degenerative disc disease (DDD) are treated surgically with instrumented lumbar fusion, which can be performed using either the anterior or posterior approach. Each approach has its advantages and its drawbacks. In this study, we evaluate transforaminal lumbar interbody fusion (TLIF) and standalone anterior lumbar interbody fusion (sa-ALIF) with respect to their clinical and radiological outcomes. Methods: This retrospective study was conducted on 53 patients suffering from low back pain (LBP) with/without radicular pain attributed to lumbar DDD, either with or without grade 1 degenerative spondylolisthesis. The patients were clustered into two groups: Group 1, 25 patients who underwent anterior approach using the stand-alone ALIF (sa-ALIF); and Group 2, 28 patients who underwent posterior TLIF. Patients were assessed using the Oswestry Disability Index (ODI) for functional status and visual analog scale (VAS) scores for both LBP and leg pain. Both techniques' outcomes were compared with respect to operative time, operative blood loss, hospital stay, ODI, VAS, spinopelvic parameters (segmental and global lumbar lordosis (LL), pelvic incidence (PI), and lumbar lordosis mismatch), spinal fusion, and complication rate. Results: The mean follow-up duration was 28 ± 4.1 months. Both techniques demonstrated substantial improvements in the ODI score, with the sa-ALIF group showing a reduction from 55 ± 14 to 19.1 ± 11, and the TLIF group exhibiting a change from 57.5 ± 15.7 to 23.2 ± 9.5 after 12 months. Additionally, reductions in LBP and leg pain were observed in both groups compared with baseline. The sa-ALIF group demonstrated shorter operative time (70 ± 15 minutes versus 125 ± 20 minutes) and less blood loss (150 ± 45 ml versus 380 ± 95 ml) than the TLIF group. The sa-ALIF group exhibited significant improvement in LL, with the mean LL modified from -55.5° ± 11° to -62.7° ± 7° in the sa-ALIF group and from -57.8° ± 9.5° to -61.9° ± 12° in the TLIF group, along with improvements in spinopelvic parameters. Nevertheless, no appreciable differences in fusion rates were observed between the two methods. The complication rates were similar between the two groups. Conclusion: Compared to TLIF, stand-alone ALIF showed superior outcome, demonstrated in decreased operative time, diminished loss of blood, shorter hospital stay, and better spinopelvic parameters improvement. Although statistically insignificant, VAS and ODI scores generally favored sa-ALIF over TLIF. Fusion rates and the incidence of adverse events were comparable between the two procedures.