Newswise — An operation called anterior lumbar interbody fusion (ALIF) benefits most patients with continued pain and other symptoms after previous, unsuccessful back surgery, reports a study in the March issue of Neurosurgery.
Led by Dr. Neil Duggal of University of Western Ontario, London, Canada, the researchers report on the results of ALIF in 33 patients with "failed back surgery syndrome." The patients—24 women and 9 men, average age 52 years—had persistent low back pain despite initial surgery, performed an average of 22 months previously.
In ALIF, a bone graft and hardware are placed to fuse two adjacent vertebrae together. The term "anterior" means that the fusion is performed on the front side of the spine. The anterior approach offers important advantages over fusion procedures performed at the posterior, or rear, of the spine.
After ALIF, the patients had significant improvement in back pain and other symptoms. Back pain scores decreased by 76% on average, while scores for leg pain decreased by 80%. Scores for daily functioning increased by 67%.
Overall, the ALIF procedure was rated successful for about 70% of patients. The results seemed best for patients with spondylolisthesis, which is dislocation between two vertebrae. The success rate was not as high for patients in whom ALIF was performed because of degeneration of the disk between two vertebrae.
Although ALIF is not a new procedure, recent years have seen renewed interest in its use for various conditions of the lower back. Persistent or recurrent symptoms after back surgery are a common problem—of over 250,000 back surgeries performed each year, an average of fifteen percent are classified as failures. Failed back surgery syndrome can be difficult to treat, with problems including the technical difficulties of repeated low back surgery and the psychological factors that are commonly involved.
The new results suggest that ALIF is helpful for most patients with failed back surgery. It may be especially useful for patients with spondylolisthesis after a previous back operation, but less so for those with disk degeneration. The authors call for randomized studies to compare ALIF with posterior surgery or other treatments for failed back surgery syndrome, preferably including thorough, standardized psychological tests and x-ray examinations.
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