Lumbar interbody fusion: Review of history, complications, and outcome comparisons among methods

Traditional lumbar spinal fusion has been achieved through a posterior or posterolateral approach. Newer techniques have evolved to include anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), direct lateral interbody fusion (DLIF), and axial lumbar interbody fusion (AxiaLIF). Given the distinct advantages and disadvantages of each procedure, it is critical for the spine surgeon to understand their utility and associated potential complications. This review aims to compare the outcomes, techniques and complications of various methods of lumbar fusion. Ovid Medline was used to search the English literature from 1950 to 2010. Additional articles provided by industry representatives were referenced. Comparison of TLIF with PLIF demonstrates improved segmental stability with both less blood loss and fewer complications with TLIF. ALIF provides better radiographic results than TLIF, although there are neither significant clinical differences, nor differences in segmental stability. Laparoscopic ALIF results in more complications and longer operative times than mini-open ALIF with no difference in clinical or radiographic outcomes. Compared to open techniques, the minimally invasive techniques yield less blood loss, decreased hospital stay, decreased postoperative back pain, and longer operative times. Each method of lumbar interbody fusion results in high rates of fusion and good clinical outcomes, despite complications and learning curves. More level 1 studies are needed to make generalizations regarding the outcomes of one method compared with another.