Clinical and radiologic outcomes of stand-alone anterior lumbar interbody fusion at L4-L5

•L4-L5 stand-alone ALIF resulted in fusion and complication rates of 91% and 7%.•At 18±7 months follow-up, all clinical scores improved from pre-operative values.•There were no significant associations between independent variables and ODI.•Global lumbar lordosis increased by 4±8° and L4-L5 lordosis by 7±6°.•Surgery had no clinically relevant effect on pelvic parameters. To assess early clinical outcomes of stand-alone minimally invasive ALIF for patients with DDD at L4-L5 and determine whether the procedure affects spino-pelvic parameters. The authors reviewed the records of all patients with DDD that underwent stand-alone minimally invasive ALIF at L4-L5 using the self-locking SynFix cage (DePuy Synthes, PA, USA). Patients were evaluated using the Oswestry Disability Index (ODI), Short Form 12, and lower back and legs pain on Visual Analog Scale. Spino-pelvic parameters were measured from whole-spine standing radiographs. From the initial cohort of 48 patients, 3 could not be reached, and 4 were reoperated due to pseudarthrosis using posterior instrumentation with bone graft, leaving 41 for clinical and radiologic evaluation. At a follow-up of 18.2 ± 7.3 months, all 5 clinical scores improved from pre-operative values. Multi-variable regressions revealed no significant associations between independent variables and ODI. Comparing pre- and post-operative radiographs: global lumbar lordosis increased by 3.6 ± 7.7° (p = 0.001), L4-L5 lordosis increased by 7.4 ± 6.1° (p