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. 2023 Dec;17(6):1139-1154.
doi: 10.31616/asj.2023.0135. Epub 2023 Dec 18.

Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis

Nolan J Brown  1 , Zach Pennington  2 , Cathleen C Kuo  3 , Alexander M Lopez  1 , Bryce Picton  1 , Sean Solomon  1 , Oanh T Nguyen  1 , Chenyi Yang  1 , Evelyne K Tantry  4 , Hania Shahin  1 , Julian Gendreau  5 , Stephen Albano  1 , Martin H Pham  6 , Michael Y Oh  1
Affiliations

Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis

Nolan J Brown et al. Asian Spine J. 2023 Dec.

Abstract

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: "(laparoscopic OR endoscopic) AND (anterior AND lumbar)." Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio's "metafor" package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

Keywords: Anterior lumbar interbody fusion; Endoscopy; Interbody fusion; Laparoscopy; Lumbar spine; Meurosurgery; Spine surgery.

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Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items in Systematic Reviews and Meta-Analyses flow diagram demonstrating the selection process.
Fig. 2
Fig. 2
Estimated weighted rates of fusion following laparoscopic anterior lumbar interbody fusion. CI, confidence interval.
Fig. 3
Fig. 3
Estimated weighted rates of complications following laparoscopic anterior lumbar interbody fusion. CI, confidence interval.
Fig. 4
Fig. 4
Estimated weighted rates of patients requiring conversion to open surgery. CI, confidence interval.
Fig. 5
Fig. 5
Estimated weighted rates of reoperation following laparoscopic anterior lumbar interbody fusion. CI, confidence interval.
Fig. 6
Fig. 6
Risk of bias assessment of included studies.
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