PT  - JOURNAL ARTICLE
AU  - Toohey, James S.
AU  - Faulks, Charlie R.
AU  - Biddau, Dean T.
AU  - Claydon, Matthew H.
AU  - Munday, Nigel R.
AU  - Malham, Gregory M.
TI  - Standalone Anterior Lumbar Interbody Fusion Without Supplementary Posterior Fixation Is Effective for Treatment of Symptomatic Grade 1 Isthmic Spondylolisthesis
AID  - 10.14444/8663
DP  - 2024 Dec 05
TA  - International Journal of Spine Surgery
PG  - 8663
4099  - https://www.ijssurgery.com/content/early/2024/12/05/8663.short
4100  - https://www.ijssurgery.com/content/early/2024/12/05/8663.full
AB  - Background There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort.Methods Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed.Results Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts’ PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery.Conclusions In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS.Clinical Relevance Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS.Level of Evidence 4.