DOI: 10.1097/bn9.0000000000000110 ISSN: 3066-8905

Comparative Clinical and Radiographic Outcomes of Mini-ALIF With Percutaneous Fixation Versus MI-TLIF in Intermediate-to-High-Grade Isthmic Spondylolisthesis

Siraj Shaikh, Daniel Coban, George Abdelmalek, Jibran Khan, Rayhan Shaikh, Cyrus Emami, Zoe Parrott, Nikhil Sahai, Ki Hwang, Kumar Sinha
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Study Design:

Retrospective cohort study.

Objective:

To compare clinical outcomes, radiographic alignment, and fusion durability between minianterior lumbar interbody fusion with percutaneous pedicle screw fixation (mini-ALIF+PPSF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in adults with intermediate-to-high-grade isthmic spondylolisthesis (IS).

Summary of Background Data:

Intermediate-to-high-grade IS places high mechanical demands on fusion constructs. The two principal minimally invasive interbody strategies are mini-ALIF+PPSF and MI-TLIF, yet comparative data focused on fusion durability, revision timing, and sagittal alignment are limited.

Methods:

Adult patients (18 y or older) with IS (Meyerding grade II or higher) who underwent 1 to 2 level instrumented fusion between L4 and S1 (2012–2020) were included. Degenerative etiologies were excluded. Patients were counseled on both procedures; approach selection reflected shared decision-making incorporating patient preference, surgeon preference, and patient-specific anatomic/risk factors influencing anterior exposure. Demographics, complications, pseudoarthrosis, revision rate and timing, radiographic parameters (PI, PT, SS, LL, and slip angle), and PROMs (VAS-back, VAS-leg, and ODI) were compared. Minimum follow-up was 24 months.

Results:

Fifty-two patients met criteria (mini-ALIF + PPSF: n=32; MI-TLIF: n=20). Baseline demographics and follow-up were similar. Pseudoarthrosis was lower with mini-ALIF + PPSF (0% vs . 15%, P =0.024). Mean time to revision was longer after mini-ALIF + PPSF (25.5 vs . 10.5 mo, P =0.044), despite similar revision rates. Radiographic parameters and changes were not significantly different between groups. Both cohorts demonstrated significant improvement in VAS and ODI, with no significant between-group differences. Complication rates were low and comparable.

Conclusion:

Both mini-ALIF+PPSF and MI-TLIF yield meaningful improvement in intermediate-to-high-grade IS. Mini-ALIF+PPSF was associated with superior fusion durability and delayed revision timing, with comparable alignment correction and PROM improvement.

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