Anterior lumbar spine reconstruction and fusion to restore lordosis and disc height for the treatment of recurrent lumbar disc prolapse. Functional and radiological outcomes.

Abstract

PURPOSE: This study evaluated the radiological and functional outcomes of anterior lumbar reconstruction for collapsed discs following recurrent disc prolapse (RDP) using stand-alone anterior lumbar interbody fusion (ALIF). We assessed functional outcomes, fusion success, and changes in disc height and lumbar lordosis. METHODS: A retrospective review was conducted on prospectively collected data from 71 patients. Patient-reported outcome measures (PROMs), including VAS for back and leg pain, ODI, and EQ-5D-5 L, were recorded preoperatively and postoperatively. Fusion was assessed using thin-slice CT scans and dynamic flexion-extension radiographs. Disc height, segmental lordosis, and total lumbar lordosis were measured before and after surgery. RESULTS: The mean follow-up period was 36.8 months. The average surgical time was 72 min per level (range: 55-110). Preoperative disc height averaged 5.8 mm (range: 3-10) and increased to 13.1 mm (range: 9-17) postoperatively (p < 0.001). Significant improvements were observed in segmental and total lordosis. The CT-confirmed fusion rate was 98.6%. PROMs showed statistically significant improvements at all postoperative follow-ups. The number of prior discectomies did not impact outcomes. However, the presence of epineural fibrosis had a statistically significant negative effect on VAS leg pain improvement. CONCLUSION: ALIF is an effective surgical option for managing RDP, particularly in cases with significant disc height and lordosis loss. This study, which represents the largest single-surgeon series to date, demonstrates excellent functional and radiological outcomes with a low complication rate.