Global Spine Journal - 2026-03-04 - Journal Article
Multilevel Standalone Anterior Plus Lateral Lumbar Interbody Fusion: A Propensity-Matched Comparison to Circumferential Lumbosacral Fusion.
Burkhard MD, Stepan T, Mielke AM, Guven AE, Verna B, Loggia G, Shue J, Girardi FP, Cammisa FP, Sama AA, Hughes AP
Topics
Key Takeaway
Standalone A+LLIF achieved a 5-year cumulative revision rate of 2.2% vs 31.1% for circumferential L+PLIF in propensity-matched multilevel lumbosacral fusion patients (P<.001).
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Summary
This single-center propensity-matched retrospective study compared standalone anterior plus lateral interbody fusion (A+LLIF) to circumferential lateral plus posterior interbody fusion (L+PLIF) for multilevel lumbosacral fusion in 90 matched patients. A+LLIF produced a 5-year revision rate of 2.2% vs 31.1% for L+PLIF (P<.001), with significantly shorter operative time, less blood loss, and shorter hospital stay. Spinopelvic alignment was largely equivalent, though A+LLIF demonstrated superior distal lordosis and LPA-PI mismatch correction (P=.003 and P=.019, respectively).
Key Limitation
The 31.1% revision rate in the L+PLIF group is exceptionally high compared to published benchmarks, raising concern that residual selection bias or center-specific technical factors—not captured by the four matching variables—may substantially inflate the apparent benefit of A+LLIF.
Original Abstract
Study DesignRetrospective Single-center propensity score-matched cohort study.ObjectiveAdjacent segment disease remains a major cause of revision surgery after multilevel lumbosacral fusion, and muscle-preserving approaches may help reduce this risk. This study compared clinical and radiographic outcomes between a muscle-preserving fusion combining standalone anterior plus lateral lumbar interbody fusion (A + LLIF) vs circumferential lateral plus posterior lumbar interbody fusion (L + PLIF).MethodsPatients who underwent multilevel lumbosacral fusion (2016-2023) with either A + LLIF or L + PLIF were included. L + PLIF patients with contraindications to standalone A + LLIF were excluded. Propensity score matching, based on age, BMI, PI-LL mismatch and stenosis severity, yielded 90 1:1-matched patients. The primary outcome was revision surgery. Secondary outcomes included spinopelvic alignment, cage subsidence, and perioperative metrics.ResultsBaseline characteristics were comparable between groups (mean age 57 ± 10 years; median fusion levels: 2 [range 2-4]). The 5-year cumulative incidence of revision surgery was significantly lower with A + LLIF (1/45 events; 2.2%) than with L + PLIF (14/45 events; 31.1%; P < .001), with superior perioperative outcomes and comparable radiographic alignment.Operative time, blood loss, and length of stay were significantly lower in the A + LLIF group ( P < .001 for all). Spinopelvic parameters were largely equivalent, except for improved distal lordosis and LPA-PI mismatch in the A + LLIF group ( P = .003 and P = .019, respectively). Cage subsidence rates were low and similar between groups.ConclusionsIn carefully selected patients, combined standalone anterior and lateral interbody fusion offers a paraspinal muscle-preserving alternative to circumferential fusion, with significantly lower revision rates, favorable perioperative outcomes, and comparable radiographic alignment.