Related Experiment Video
Updated: Sep 19, 2025
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
L4-S1 ALIF restores and maintains lordosis while minimizing adjacent segment disease compared to L4-S1 TLIF
Yi Zhang1, Ved A Vengsarkar2, Jialun Chi3
1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA; Department of Spine Surgery, Spinal Deformity Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
Anterior lumbar interbody fusion (ALIF) is more effective than transforaminal lumbar interbody fusion (TLIF) for L4-S1 degenerative disc disease. ALIF better restores lordosis and significantly reduces adjacent segment disease (ASD) and reoperations.
Area of Science:
- Spine surgery
- Degenerative disc disease
- Lumbar fusion techniques
Background:
- The L4-S1 region is crucial for lumbar lordosis.
- Adjacent segment disease (ASD) is a common complication after lumbar interbody fusion.
- No direct comparison exists for ASD incidence between ALIF and TLIF for L4-S1 degenerative disc disease.
Purpose of the Study:
- To compare the efficacy of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF).
- To evaluate the restoration and maintenance of L4-S1 lordosis.
- To assess the impact on adjacent segment disease (ASD) development.
Main Methods:
- Retrospective cohort study of 155 patients (53 ALIF, 102 TLIF) undergoing L4-S1 fusion for degenerative lumbar disease.
- Collected demographic, surgical, and radiographic data from January 2017 to December 2021.
- Assessed sagittal parameters preoperatively, postoperatively, and at final follow-up (mean 45.8 months).
Main Results:
- ALIF achieved a greater increase in L4-S1 lordosis (6.5° vs. 1.3°) and reduced compensatory L3/4 changes (-2.4° vs. 0.2°) compared to TLIF.
- ALIF demonstrated a lower incidence of ASD (3.8% vs. 15.7%) and fewer reoperations (7.5% vs. 25.5%).
- Increased postoperative L4-S1 lordosis and decreased delta L3/4 were associated with reduced ASD risk.
Conclusions:
- ALIF is superior to TLIF in restoring and maintaining L4-S1 lordosis.
- ALIF effectively mitigates compensatory lordosis and reduces the incidence of adjacent segment disease.
- ALIF leads to significantly fewer reoperations compared to TLIF.
