Stand-alone anterior lumbar discectomy and fusion with plate: initial experience

The stability of the lumbar spine after ALIF with lateral plate fixation and/or posterior fixation has previously been investigated; however, stand-alone ALDF with plate has not. Previous clinical studies have demonstrated poor fusion rates with stand-alone anterior interbody fusion in the absence of posterior instrumentation. We review our initial experience with stand-alone ALDF with segmental plate fixation for degenerative disc disease of the lumbar spine and compare these results with our experience with traditional ALIF and supplemental posterior instrumentation.

Forty-nine patients treated at the University of California, San Francisco between 2002 and 2005 were included in this analysis. The study was retrospective in nature. All patients presented with discogram-positive back pain and had failed conservative treatment. Twenty-four patients underwent ALDF with plate, and 25 underwent ALIF with posterior instrumentation. Patients underwent flexion/extension imaging at 6 weeks, 3 months, 6 months, and 1 year postoperatively. All patients completed ODI and VAS questionnaires at 3 months, 6 months, and 1 year postoperatively.

Average follow-up was 11.6 and 21.7 months in the ALDF with plate and ALIF with instrumentation groups, respectively. All patients demonstrated radiographic evidence of fusion at last follow-up. None developed instability at the fusion level, and none developed hardware failure (plate back-out, screw lucency, etc). Average subsidence at 6 months postoperatively was 2.2 and 2.5 mm, respectively. The VAS and ODI scores are presented in Tables 3 and 4.

Preliminary results of stand-alone ALDF with plate suggest it may be safe and effective for the surgical treatment of patients with degenerative disc disease of the lumbar spine. Long-term follow-up is clearly needed. Subsidence is diminished with ALDF and plating compared with ALIF with posterior instrumentation. It is unclear at this time which subset of patients may ultimately require posterior hardware supplementation, but those with circumferential stenosis or severe facet disease are not ideal candidates for ALDF with plate. For some patients in whom lumbar arthroplasty is not indicated, or as a salvage procedure, ALDF with plate may be a satisfactory alternative and may eliminate the need for a supplemental posterior procedure.