Comparative analysis of ALIF and TLIF in recurrent L5–S1 intervertebral disc disease

Objective. To analyze the immediate and long-term results of surgical treatment of recurrent single-level herniated L5–S1 intervertebral disc using the methods of total removal of the affected disc through anterior approach with spondylodesis (ALIF) and discectomy from the posterior approach with transforaminal spondylodesis (TLIF).

Material and Methods. A total of 180 patients (ALIF group – 87, TLIF group – 93) were operated on for recurrent single-level lumbosacral L5–S1 intervertebral disc disease. The average time to recurrence was 3 years ± 5 months.

Results. The average duration of surgery for ALIF was 92±14 min, for TLIF – 120 ± 18 min (p < 0.05). Сomparison of preoperative and postoperative VAS scores showed that pain syndrome reliably regressed almost completely in patients of the ALIF group. In the TLIF group (n = 93), pain syndrome also regressed, but to a lesser extent. Functional assessment according to ODI revealed positive dynamics after surgery in all patients. Despite the positive dynamics in both groups, the difference in the degree of improvement was statistically significant in favor of ALIF (p < 0.05). In accordance with the modified MacNab scale, the overwhelming majority of patients in the ALIF group rated the outcome as excellent, while in the TLIF group – as good. In the ALIF and TLIF groups, a comparable high percentage of a complete bone block formation was recorded. Insufficient fusion was recorded in four patients. Better restoration of lumbar lordosis was noted in the ALIF group. The average increase in the lordosis angle in the ALIF group was 11.5° ± 2.1°, in the TLIF group – 3.9° ± 0.8° (p < 0.01).

Conclusion. ALIF and TLIF are effective methods of surgical treatment for recurrent single-level L5–S1 intervertebral disc disease. Despite the technical complexity and certain limitations of the anterior approach, ALIF can be considered as a preferred surgical approach for recurrent L5–S1 disc herniation, especially in patients with sagittal profile abnormalities, severe pain, and the need to restore the height of the intervertebral space.

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