Comparison of Posterior and Transforaminal Approaches to Lumbar Interbody Fusion

Humphreys, S. Craig; Hodges, Scott D.; Patwardhan, Avinash G.; Eck, Jason C.; Murphy, R B; Covington, L A

doi:10.1097/00007632-200103010-00023

Cited by 399 publications

(252 citation statements)

References 13 publications

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“…Intraoperative complications in the TLIF group were all neurological and our rate (4.6%) was similar to previous publications describing complications after PLIF procedures [13,20,26]. Strikingly, there was a significantly higher rate of early revision surgery in the TLIF group.…”

Section: Discussionsupporting

confidence: 88%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

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Abundant data are available for direct anterior/ posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre-and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

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Section: Discussionsupporting

confidence: 88%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

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show abstract

“…In a series of 298 patients, Glassman et al [30] observed that anterior translation of the spine TLIF procedure TLIF procedures have been widely used since their first description in 1998 [31]. They have showed to improve disc space height and initial stability of the construct in comparison to posterolateral fusion [9]. In addition, the procedure is effective in improving sagittal spinal alignment, in combination with posterior instrumentation, if the appropriate surgical technique is implemented [24].…”

Section: Preoperative Analysismentioning

confidence: 99%

“…With TLIF, because the preparation of the disc space and placement of the interbody cage is transforaminal, traction on the nerve root and the dura is minimized. Consequently, while clinical outcomes and fusion rates of TLIF and PLIF are comparable [9], TLIF is associated with a lower risk of postoperative radiculitis [10,11].…”

Section: Introductionmentioning

confidence: 99%

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

et al. 2011

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Introduction Restitution of sagittal balance is important after lumbar fusion, because it improves fusion rate and may reduce the rate of adjacent segment disease. The purpose of the present study was to describe the impact of transforaminal lumbar interbody fusion (TLIF) procedures on pelvic and spinal parameters and sagittal balance. Materials and methods Forty-five patients who had single-level TLIF were included in this study. Pelvic and spinal radiological parameters of sagittal balance were measured preoperatively, postoperatively and at latest follow-up. Results Age at surgery averaged 58.4 (±9.6) years. Mean follow-up was 35.1 months (±4.1). Twenty-nine percent of the patients exhibited anterior imbalance preoperatively, with high pelvic tilt (17.6°± 7.9°). Of the 32 (71%) patients well balanced before the procedure, 22 (70%) had a large pelvic tilt ([20°), due to retroversion of the pelvis as an adaptive response to the loss of lordosis. Three dural tears (7%) were reported intraoperatively. Interbody cages were more posterior than intended in 27% of the cases. Disc height and lumbar lordosis at fusion level significantly increased postoperatively (p \ 0.05 and p \ 0.001). Pelvic tilt was significantly reduced (p \ 0.01) postoperatively, whereas the global sagittal balance was not significantly modified (p = 0.07). ConclusionSingle-level circumferential fusion helps patients reducing their pelvic compensation, but the amount of correction does not allow for complete correction of sagittal imbalance.

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“…Transforaminal lumbar interbody fusion (TLIF) was popularized by Harms et al [4] as an alternative to PLIF. TLIF offers several advantages including decreased retraction of the dural sac, lessening the risk of postoperative radiculitis [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2

et al. 2010

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Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiT-LIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time.

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Comparison of Posterior and Transforaminal Approaches to Lumbar Interbody Fusion

Cited by 399 publications

References 13 publications

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2

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