A systematic review and meta-analysis of the clinical efficacy of anterior lumbar interbody fusion in the treatment of orthopedic spondylolisthesis

Background: Many studies have reported the advantages of anterior lumbar interbody fusion (ALIF), but the technique is associated with many complications involving nerve injury. This meta-analysis compared the outcome indicators associated with 2 fusion methods, namely, ALIF and posterolateral fusion (PLF). The clinical efficacy of ALIF was explored to provide evidence-based data for the determination of surgical methods for treating orthopedic spondylolisthesis. Methods: Relevant literatures were retrieved from the CBMdisc, CNKI, PubMed, EBSCO, MEDLINE, Science Direct, and Cochrane databases. Keywords in Chinese and English included spondylolisthesis, spine, surgical treatment, ALIF, and PLF. Data including the visual analogue scale (VAS) score, the Oswestry Disability Index (ODI), time of operation, and fusion rate were collated. According to Cochrane manual, Rev Man 5.3 software was used for analysis. Results: A total of 6 articles were included in this meta-analysis. There were significant differences in intraoperative blood loss [Z=3.34; mean difference (MD) =-142.54; 95% confidence interval (CI): -226.17 to -58.92; P=0.0008] and operation time (Z=5.45; MD =-54.31; 95% CI: -73.83 to -34.79; P<0.00001) between patients in the ALIF group and patients in the PLF group. Significant differences were observed in VAS score (Z=3.55; MD =-1.04; 95% CI: -1.62 to -0.47; P=0.0004) nor ODI score (Z=3.07; MD =-6.33; 95% CI: -10.37 to -2.28; P=0.002) between the ALIF group and the PLF group. Interestingly, there was a significant difference in the hospitalization time between the 2 groups (Z=2.39; MD=-1.48; 95% CI: -2.70 to -0.27; P=0.02). Bone fusion rate was no significantly different between patients in the ALIF group and patients in the PLF group [Z=0.43; odds ratio (OR) =0.42; 95% CI: 0.01 to 21.82; P=0.66]. Discussion: The results of this meta-analysis confirmed that ALIF can effectively improve the degree of spondylolisthesis, provide superior structural stability, and ensure surgical efficacy.