Comparison of early clinico-radiological outcome of posterolateral fusion and transforaminal lumbar interbody fusion techniques
Keywords:Posterolateral fusion, Transforaminal lumbar Interbody fusion
Background: The objective is to analyse clinico-radiological outcome with respect to functional disability, pain, fusion rate of patients treated with TLIF compared to instrumented PLF techniques for lumbar spinal stabilization.
Methods: Monocentric retrospective study with an average follow up of 36 months in patients who underwent surgery from January 2016 to December 2017. Out of 140 participants, 78 males and 62 females with mean age 52.22 (±11.97) years; 78 underwent PLF and 62 underwent TLIF. Assessment was done using VAS score and ODI score before surgery and post-surgery at 3, 6, and 18 weeks and thereafter at 18, 24 and 36 months. Radiologically sagittal and coronal angles were measured both preoperatively and postoperatively and evaluation of correction in sagittal and coronal angle was calculated.
Results: We observed highly significant reduction in the post-operative VAS score, ODI Score compared to pre-operative scores in both TLIF and PLF group but radiologically TLIF gives better correction in sagittal balance and rotational alignment compared to PLF.
Conclusions: We conclude that in the short term duration of our study, both the procedures done with proper technique in duly indicated patients shows satisfactory clinical outcome. However, radiologically TLIF patients had better outcome. We expect better outcome in long term with TLIF compared to PLF. In presence of insignificant blood loss, surgical duration and better 3600 fusion TLIF is preferred over PLF.
Issack PS, Cunningham ME, Pumberger M, Hughes AP, Cammisa FP. Degenerative lumbar spinal stenosis: evaluation and management. J Am Acad Orthop Surg. 2012;20:527-35.
Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine. 2005;30:936-43.
Bydon M, Macki M, Abt NB, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A, Sciubba DM. The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis. Spine J. 2015;15(3):492-8.
Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine. 2012;37(1):67-76.
Audat Z, Moutasem O, Yousef K, Mohammad B. Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine. Singapore Med J. 2012;53(3):183-7.
Høy K, Bünger C, Niederman B, Helmig P, Hansen ES, Li H, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: A randomized clinical trial with 2-year followup. Eur Spine J. 2013;22:2022-9.
Videbaek TS, Christensen FB, Soegaard R, Hansen ES, Høy K, Helmig P, Niedermann B, Eiskjoer SP, Bünger CE. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine. 2006;31(25):2875-80.