Anterior lumbar fusion vs posterolateral fusion for backpain
Research type
Research Study
Full title
Anterior lumbar interbody fusion vs posterolateral fusion for lower back pain; a long term comparative analysis
IRAS ID
104851
Contact name
Birender Balain
Contact email
Sponsor organisation
Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Research summary
Back pain not responding to conservative measures like painkillers, exercises and activity modifications has been treated by a variety of surgical procedures. There are five mobile discs in the lumbar spine. When the process of wear and tear is restricted to one or two levels, with the other levels being normal, abolishing motion at these levels by means of a fusion surgery is likely to reduce back pain. Fusion surgery has had satisfactory results in carefully selected patients.
Fusion in the Lumbar spine is achieved either using an anterior approach (Anterior lumbar inter-body fusion- ALIF) or a posterior approach (postero-lateral inter transverse fusion-PLF) or combined techniques (circumferential fusion). Reliable results favouring one approach over the other in the treatment of disc degenerative disease are not available.
Fusion at one or more levels leads to hypermobility at adjacent levels as per cadaveric studies. This leads to Adjacent Segment Degeneration (ASD) and resulting symptoms at adjacent levels is one factor most likely to settle the question of suitability of ALIF versus PLF. These usually present in the form of worsening back pain or leg pain due to pressure on the nerves.
The presence of adjacent segment degeneration and disease in patients with either ALIF or PLF after long term follow up will help determine which approach fares better in the long term. Biomechanical factors like types of instrumentation, number of levels fused and restoration of normal lumbar curvature (lordosis) affect the outcome, and hence need to be taken into consideration.
This study aims to study the clinical effectiveness of ALIF and PLF and determine which approach fares better in the long term. With a vast pool of patients who have had these two different surgical approaches in the past, the RJAH Orthopaedic Hospital is ideally suited for this study.REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
14/NW/0217
Date of REC Opinion
17 Apr 2014
REC opinion
Favourable Opinion