Microscopic Anterior Lumbar lnterbody Fusion for Lumbar Radiculopathy

Anterior lumbar interbody fusion (ALIF) is an option for patients with low back pain attributed to degenerative disc disease. However, patients with radiculopathy who are also candidates for fusion have been commonly treated with posterior lumbar interbody fusion (PLIF), usually with pedicle screw instrumentation.

We present a modification of the ALIF technique using the operating microscope in which the herniated disc or osteophytes compressing traversing nerve roots are removed in addition to a complete discectomy and fusion with threaded bone dowels. Six patients (ages 29–51) underwent single segment microscopic ALIF for chronic, discogenic low back pain with radiculopathy. One patient had prior surgery at the operated level. These patients would have otherwise been candidates for a PLIF procedure. All patients had resolution (5/6) or improvement (1/6) of their radicular symptoms, and resolution (4/6) or marked improvement (216) of their low back pain. Complications were limited to one case of transient groin pain related to graft harvesting. In an average follow–up of 4 months, all patients returned to their previous activities, including work. One patient is still taking narcotics, but at a lower dose.

Microscopic ALIF is indicated in patents with degenerative lumbar disc disease and radicular symptoms without significant instability who would otherwise be candidates for a PLIF procedure. Nerve root retraction, posterior instrumentation, paraspinal muscle denervation, and related stiffness are avoided. This results in a shorter operative time, shorter hospital stay, and in our hands yields clinical results comparable to the PLIF procedure. cogram and limitation of fusion to a single level were associated with a good outcome.