Anterior Lumbar Interbody Fusion versus Posterior Transforaminal Lumbar Interbody Fusion for treatment of Lumbar Degenerative Diseases. - Trial PACTR202211721074384
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Study Focus
procedure
Sponsor & Location
Assiut university
self funded
Timeline & Enrollment
Early Phase 1
Oct 25, 2022
Dec 04, 2024
Summary
Degenerative lumbar spine diseases cause major functional disability. Fusion is the cornerstone of management for an unstable degenerative spinal disease; however, various techniques are available either anterior or posterior. The posterior approach is used to achieve posterior interbody fusion; however, to avoid direct manipulation of the nerves, Anterior Lumbar Interbody Fusion approaches were introduced to maintain spinal fusion and indirect decompression. Compared to open posterior surgery, these surgical approaches lessen postoperative back pain, surgical procedures time, and blood loss.The retroperitoneal approach in ALIF, is performed between the deep side of the rectus abdominis and the peritoneum, either right or left for L5S1 and left for upper or multiple levels L2-5; however in the anterior to psoas technique (ATP), it is through the external, internal oblique and transverse muscle fibres to the retroperitoneal space. In ALIF, the access to the disc space is direct anterior through anterior longitudinal ligament, however in ATP, it follows an oblique trajectory to the anterolateral side of the annulus. Both approaches can be used between L2 -S1 but ATP is more challenging at L5 - S1as high iliac crest, this can managed by folding the table towards the feet to create enough space and by using curved instruments which can go under the iliac crest (7). ATP tries to prevent disturbance of the psoas and lumbosacral plexus in the direct lateral trans-psoas approaches by following an oblique trajectory. ATP also avoids the vascular manipulation, which enables many spine surgeons to operate without vascular surgeon assistance. Our aim in this study is to investigate which technique is safer, less invasive and more effective in achieving patient satisfaction, sagittal realignment and higher fusion rate.
ICD-10 Classifications
Data Source
Pan Africa Clinical Trials Registry
PACTR202211721074384
Non-Device Trial