ORIGINAL
Introdução: A artrodese lombar intersomática anterior (ALIF) é opção estabelecida para doenças degenerativas lombares, restaurando altura discal, promovendo descompressão indireta e correção do equilíbrio sagital, com preservação posterior. Contudo, dados brasileiros sobre desfechos e segurança são escassos. Objetivo: Relatar a experiência institucional com ALIF, com foco em desfechos clínicos de curto prazo e segurança perioperatória. Métodos: Série retrospectiva consecutiva de pacientes submetidos à ALIF (maio/2021–novembro/2024), com dados de banco prospectivo. Desfechos primários: complicações pós-operatórias e melhora da dor (EVA) pré-operatória e aos seis meses. Desfechos Secundários: tempo cirúrgico, perda sanguínea e tempo de internação. Resultados: Incluídos 28 pacientes (idade média 53,8 anos; 71% mulheres). Predominaram níveis L4–L5–S1, com configuração 360° em 85,7%. A EVA reduziu de 9,0 para 3,1 (p < 0,0001). Complicações foram pouco frequentes e autolimitadas: parestesia transitória (10,7%), pequeno hematoma epidural (10,7%) e alterações simpáticas temporárias (7,1%). Um paciente necessitou reoperação; não houve lesões vasculares ou durais. Conclusão: A ALIF gerou alívio significativo da dor em curto prazo, com baixa taxa de complicações, sendo segura e viável em centros brasileiros.
Introduction: Anterior lumbar interbody fusion (ALIF) is an established surgical option for degenerative lumbar disease, allowing disc height restoration, indirect decompression, and sagittal balance correction while preserving posterior elements. However, Brazilian outcome and safety data remain scarce. Objective: To report an institutional experience with ALIF for degenerative lumbar disease, focusing on short-term clinical outcomes and perioperative safety. Methods: This retrospective consecutive case series included patients who underwent ALIF between May 2021 and November 2024. Data were obtained from a prospectively maintained database. Primary outcomes were postoperative complications and pain improvement measured by the visual analogue scale (VAS) preoperatively and at six months. Secondary outcomes included operative time, blood loss, and hospital stay. Results: Twenty-eight patients were analyzed (mean age 53.8 years; 71% female). Most procedures involved L4–L5–S1, and 85.7% used a 360° configuration. Mean VAS improved from 9.0 to 3.1 (p < 0.0001). Complications were infrequent and self-limited, including transient paresthesia (10.7%), small epidural hematoma (10.7%), and temporary sympathetic changes (7.1%). One patient required reoperation. No vascular or dural injuries occurred. Conclusion: ALIF provided significant short-term pain relief with low complication rates, supporting its safety and feasibility in Brazilian centers.
1. Barber SM, Sulhan S, Schwartz L, Konakondla S. Anterior lumbar interbody fusion: patient selection and workup. J Spine Surg. 2024;10(4):706-14. https://doi.org/10.21037/jss-24-88. PMid:39816775.
2. Khela M, Agha O, Sawires A, Metz L. The modern application of anterior lumbar interbody fusion (ALIF): a narrative review of perioperative considerations and surgical pearls. J Spine Surg. 2025;11(1):148-65. https://doi.org/10.21037/jss-24-85. PMid:40242817.
3. Rathbone J, Rackham M, Nielsen D, et al. A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior approaches. Eur Spine J. 2023;32(8):1911-26. https://doi.org/10.1007/s00586-02307567-x. PMid:37071155.
4. Alhaug OK, Dolatowski FC, Thyrhaug AM, Mjønes S, Dos Reis JABPR, Austevoll I. Long-term comparison of anterior (ALIF) versus transforaminal (TLIF) lumbar interbody fusion: a propensity score– matched register-based study. Eur Spine J. 2024;33(3):1109-19. https:// doi.org/10.1007/s00586-023-08060-1. PMid:38078979.
5. Pereira Filho ARD, Baptista VS, Mussalem MGVB, et al. Incidence of intraoperative morbidities in anterior lumbar interbody fusion (ALIF): a comprehensive study of 5,299 levels. Neurosurg Rev. 2025;48(1):327. https://doi.org/10.1007/s10143-025-03496-z. PMid:40138083. 6. Tigre JY, Mummaneni PV, Veeravagu A, et al. Risk factors for J Neurosurg Spine. 2021;35(4):427-36. https://doi.org/10.3171/2020.12. SPINE201101. PMid:34271542.
8. Lau D, Lee J, Han SJ, Lu DC, Chou D. Anterior lumbar interbody fusion for degenerative spine disease: outcomes and complications in 497 patients. J Neurosurg Spine. 2019;30(5):563-70.
9. Kim JS, Choi WS, Lee SH. Clinical and radiographic outcomes of anterior lumbar interbody fusion for degenerative disc disease. World Neurosurg. 2020;134:e100-8.
10. Berjano P, Lau D, Mundis GM Jr, et al. Minimally invasive anterior and lateral approaches for lumbar interbody fusion: state of the art. Eur Spine J. 2015;24(Suppl 7):879-91.
11. Manunga J, Yue JJ, Zampini JM. Vascular complications of anterior lumbar interbody fusion: lessons learned from 1000 cases. Spine J. 2020;20(8):1239-48. PMid:32061837.
12. Ohtori S, Koshi T, Inoue G, Yamashita M, Suzuki M, Takahashi K. Neurological and autonomic symptoms after anterior lumbar interbody fusion: prospective analysis. Spine. 2018;43(14):E845-52.
13. Cunningham J, Pradhan BB, Dailey AT. Comparison of stand-alone ALIF versus circumferential fusion in lumbar degenerative disease. Global Spine J. 2020;10(8):987-95.
14. Nanda A, Zhao F, Teli M, Hsieh PC. Comparison of anterior, posterior, and circumferential lumbar fusion outcomes in degenerative disease. Spine Deform. 2021;9(6):1380-9.
15. Rao PJ, Phan K, Mobbs RJ. Complications and functional outcomes of anterior lumbar interbody fusion in a contemporary series. Eur Spine J. 2020;29(3):452-60.
1Instituto do Cérebro, Fundação de Neurologia e Neurocirurgia, Salvador, BA, Brazil.
2Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Received Oct 13, 2025
Corrected: Feb 13, 2026
Accepted Feb 14, 2026
