Comparative analysis of transforaminal lumbar interbody fusion versus posterolateral instrumented fusion in degenerative lumbar spine disorders

Abstract

Objectives: Spinal fusion is an effective treatment for degenerative lumbar spine; however, conflicting results exist regarding the best procedure. This study compares the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) versus instrumented posterolateral fusion (PLF) in patients of degenerative lumbar spine disorders. Methods: Of the total 37 patients, 16 patients were operated with TLIF and 21 were operated with instrumented PLF with bone grafting. Duration of the study was from June 2017 to June 2019. Patients fulfilling the inclusion criteria were included in the study. Inclusion criteria were (1) age of patient ranging from 18 years to 70 years, (2) involvement of single level, (3) diagnosis of degenerative spine disease, and (4) minimum follow-up of 1 year. Radiographic parameters such as slippage of vertebrae, anterior and posterior disc heights, local disc lordosis, T12–S1 angle were measured, and fusion were assessed; comparison between preoperative and postoperative parameters was also done. Clinical outcome score was obtained using visual analog scale (VAS) and Oswestry disability index (ODI). Statistical analysis was done using SPSS software. Results: No significant difference was found in ODI and VAS between TLIF and PLF. Restoration of disc height and improvement of local disc lordosis was better in the TLIF group than in the PLF group. The fusion rate was 87.5% in the TLIF group and 81% in the instrumented PLF group. Amount of blood loss was slightly higher in the TLIF group (319.69 ± 53.8 mL) than in the instrumented PLF group (261.19 ± 34.9 mL). Operating time was also slightly higher in TLIF (133 ± 6.02 min) than in instrumented PLF (90.71 ± 6.3 min). Conclusion: TLIF is superior to instrumented PLF in terms of restoration of anterior and posterior disc heights and improvement in local disc lordosis and higher fusion rate, however it requires greater surgical expertise and more experience. Because of anterior cage support, early weight-bearing mobilization can be allowed in the TLIF group compared to the PLF group. Surgical time and blood loss were slightly higher in cases of TLIF than instrumented PLF.