Anterior Lumbar Interbody Fusion Versus Lumbar Disk Arthroplasty: A Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes in Degenerative Disk Disease
Journal
Operative Neurosurgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Date Issued
2026
Author(s)
Cortez Barros, Bianca Lima
Silva Cavalcante, Deivyd Vieira
de Oliveira, Helen Michaela
Cortez Barros, Ronaldo
Vig, Ananya
Leite Barros, Yanne Luisa
Trejo Elías, José Eduardo
Dastagir, O. Z. M.
Type
Article
Abstract
BACKGROUND AND OBJECTIVES:
Low back pain is the leading musculoskeletal disorder worldwide, with lumbar degenerative disk disease (DDD) as a major cause, leading to chronic disability and socioeconomic burden. Surgery is considered after conservative management fails. Anterior lumbar interbody fusion (ALIF), the gold standard, is limited by adjacent segment degeneration and revision risk. Lumbar disk arthroplasty (LDA) was developed to preserve motion and reduce fusion-related complications. Although trials suggest superior short-term outcomes, concerns over durability, patient selection, and inconsistent reporting keep its long-term role controversial.
METHODS:
We systematically searched PubMed, Embase, and CENTRAL through July 2025. Studies comparing short-term and long-term outcomes of ALIF and LDA in patients with DDD were included. Risk of bias was assessed using Risk of Bias in Randomized Studies and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was graded using Grading of Recommendations Assessment, Development, and Evaluation. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251134113).
RESULTS:
Thirteen reports (6 randomized controlled trials and 7 nonrandomized clinical trials) comprising 3600 patients were included. LDA was associated with higher overall success (risk ratio [RR] 1.15; 95% CI 1.07-1.24;
P
= .001) and lower visual analog scale pain scores (mean difference −0.89; 95% CI −1.73 to −0.06;
P
= .037) but also demonstrated higher revision (RR 3.07; 95% CI 1.13-8.35;
P
= .028) and reoperation rate (RR 2.56; 95% CI 1.34-4.90;
P
= .005) compared with ALIF. Device-related adverse events were higher with ALIF (RR 0.41; 95% CI 0.25-0.68;
P
< .001). Patient satisfaction favored LDA (RR 1.22; 95% CI 1.09-1.36;
P
< .001). Also, LDA had shorter hospital stays (mean difference −0.54; 95% CI −1.00 to −0.07;
P
= .023).
CONCLUSION:
LDA demonstrated short-term recovery and patient-reported outcomes benefits. ALIF offers greater long-term stability with fewer secondary procedures. However, these findings should be interpreted cautiously, given the predominantly low to very low certainty of evidence according to Grading of Recommendations Assessment, Development, and Evaluation. Larger, well-designed trials with longer follow-up and standardized outcome reporting are needed to better inform surgical decision-making in DDD.
Low back pain is the leading musculoskeletal disorder worldwide, with lumbar degenerative disk disease (DDD) as a major cause, leading to chronic disability and socioeconomic burden. Surgery is considered after conservative management fails. Anterior lumbar interbody fusion (ALIF), the gold standard, is limited by adjacent segment degeneration and revision risk. Lumbar disk arthroplasty (LDA) was developed to preserve motion and reduce fusion-related complications. Although trials suggest superior short-term outcomes, concerns over durability, patient selection, and inconsistent reporting keep its long-term role controversial.
METHODS:
We systematically searched PubMed, Embase, and CENTRAL through July 2025. Studies comparing short-term and long-term outcomes of ALIF and LDA in patients with DDD were included. Risk of bias was assessed using Risk of Bias in Randomized Studies and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was graded using Grading of Recommendations Assessment, Development, and Evaluation. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251134113).
RESULTS:
Thirteen reports (6 randomized controlled trials and 7 nonrandomized clinical trials) comprising 3600 patients were included. LDA was associated with higher overall success (risk ratio [RR] 1.15; 95% CI 1.07-1.24;
P
= .001) and lower visual analog scale pain scores (mean difference −0.89; 95% CI −1.73 to −0.06;
P
= .037) but also demonstrated higher revision (RR 3.07; 95% CI 1.13-8.35;
P
= .028) and reoperation rate (RR 2.56; 95% CI 1.34-4.90;
P
= .005) compared with ALIF. Device-related adverse events were higher with ALIF (RR 0.41; 95% CI 0.25-0.68;
P
< .001). Patient satisfaction favored LDA (RR 1.22; 95% CI 1.09-1.36;
P
< .001). Also, LDA had shorter hospital stays (mean difference −0.54; 95% CI −1.00 to −0.07;
P
= .023).
CONCLUSION:
LDA demonstrated short-term recovery and patient-reported outcomes benefits. ALIF offers greater long-term stability with fewer secondary procedures. However, these findings should be interpreted cautiously, given the predominantly low to very low certainty of evidence according to Grading of Recommendations Assessment, Development, and Evaluation. Larger, well-designed trials with longer follow-up and standardized outcome reporting are needed to better inform surgical decision-making in DDD.