Introduction: Lumbar fusion is one of the most frequently recommended treatments in spinal surgery, whereas ALIF and PLF are discussed controversially. This prospective and consecutive study examined if complications and rehabilitation differed between patients with a degenerated lumbar spine, who had been treated with ALIF or PLF.

Methods: Between 04/2002 and 12/2005 clinical data of 39 patients, who were treated with ALIF, and of 296 patients, who received PLF, were submitted to the European Spine Register SSE Spine Tango. Complications and rehabilitation process were documented after a median follow-up time of 9 weeks (IQR 8–24 weeks). Analysis was performed with non-parametric tests. The study corresponds with an EBM-level 3.

Results: The median age of patients with ALIF was 56 years (IQR 37-66 yrs) vs. 64 yrs in the PLF group (IQR 54–72 yrs) with a male to female ratio 10:29 vs. 108:188.

Patients after ALIF and PLF had an even complication rate (5/39 vs. 26/296, p = 0,41). The types of complications in the ALIF group were less severe (sensory and motoric disturbance vs. implant failure and implant malposition). All five patients needing reintervention belonged to the PLF group. Three quarters of all patients underwent rehabilitation. The proportion of patients with outpatient rehabilitation was higher in the ALIF group (14/39 vs. 50/296 patients, p = 0,05).

Conclusions: Patients with degenerative lumbar spine disease have a less severe type of complications after ALIF than after PLF, whereas the complication rate is even. Concerning the higher proportion of patients with outpatient rehabilitation in the ALIF group, one has to consider their lower age compared with patients in the PLF group. Except for the severeness of complications and the proportion of outpatient rehabilitation one cannot conclude an advantage of either of the two surgical methods.