Surgical treatment of degenerative disc disease using anterior or posterior interbody fusion

Background. Anterior or posterior interbody fusion is performed to stabilise the mechanically inadequate segment of the lumbar spine. Posterior lumbar interbody fusion allows for simultaneous decompression of the spinal canal and restoration of the sagittal profile. Anterior interbody fusion allows for stabilisation of the segment without opening the spinal canal. The choice of technique has been the subject of much discussion. Material and methods. 111 patients with degenerative discopathy in the lumbar spine were treated surgically with either PLIF (Posterior Lumbar Intervertebral Fusion) or ALIF (Anterior Lumbar Intervertebral Fusion). The former group consisted of patients with nerve root symptoms; the latter, of patient with discogenic spinal pain. The outcomes were evaluated according to the Oswestry Index, the VAS, and patient satisfaction. Results. There were significant differences between groups in clinical presentation and radiological imaging. The main indication in the PLIF group was the need to decompress the nerve root. In the ALIF group, with no need to open the spinal canal, anterior fusion was performed from the extraperitoneal approach. In preliminary outcome analysis postoperative improvement was noted sooner in the ALIF group. Completion of the outcome analysis is in progress to assess the long-term effectiveness of these techniques. Conclusions. In my opinion the emphasis should be placed on early and proper diagnostic assessment allowing for the introduction of appropriate treatment including surgical intervention, at least in some groups of patients.