Manjot Singh, Ashley Knebel, Michael J Kuharski, Joseph E Nassar, Tucker Callanan, Bryce A Basques, Eren O Kuris, Bassel G Diebo, Alan H Daniels
{"title":"L4-S1 单层腰椎椎间融合术（ALIF）与两层腰椎椎间融合术（ALIF）：并发症、对位和患者疗效的比较。","authors":"Manjot Singh, Ashley Knebel, Michael J Kuharski, Joseph E Nassar, Tucker Callanan, Bryce A Basques, Eren O Kuris, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005133","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.</p><p><strong>Background: </strong>Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.</p><p><strong>Materials and methods: </strong>Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.</p><p><strong>Results: </strong>In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5 vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.</p><p><strong>Conclusion: </strong>In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"271-276"},"PeriodicalIF":2.6000,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"One-Level Versus Two-Level Anterior Lumbar Interbody Fusion (ALIF) From L4 to S1 : Comparison of Complications, Alignment, and Patient Outcomes.\",\"authors\":\"Manjot Singh, Ashley Knebel, Michael J Kuharski, Joseph E Nassar, Tucker Callanan, Bryce A Basques, Eren O Kuris, Bassel G Diebo, Alan H Daniels\",\"doi\":\"10.1097/BRS.0000000000005133\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.</p><p><strong>Background: </strong>Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.</p><p><strong>Materials and methods: </strong>Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.</p><p><strong>Results: </strong>In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5 vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.</p><p><strong>Conclusion: </strong>In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.</p><p><strong>Level of evidence: </strong>Level IV.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"271-276\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-02-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005133\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005133","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
One-Level Versus Two-Level Anterior Lumbar Interbody Fusion (ALIF) From L4 to S1 : Comparison of Complications, Alignment, and Patient Outcomes.
Study design: Retrospective cohort study.
Objective: Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.
Background: Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.
Materials and methods: Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.
Results: In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5 vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.
Conclusion: In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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