Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N2QOD data

Carreon, Leah Y.; Glassman, Steven D.; Ghogawala, Zoher; Mummaneni, Praveen V.; McGirt, Matthew J.; Asher, Anthony L.

doi:10.3171/2015.10.spine15917

Cited by 29 publications

(14 citation statements)

References 34 publications

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“…Overall incidence is 62.5% for L4-L5 and 35% for L5-S1 level. 18 In our study, we also observed 88.76% and 89.6% improvement in VAS scores for back pain, 94.8% and 96.5% increase in VAS for leg pain in PLF and TLIF groups respectively. Higher percentage of improvement was seen in TLIF patients, though the difference between the groups is not statistically significant.…”

Section: Discussionsupporting

confidence: 80%

“…16 Etemadifar et al, in their RCT, observe that ODI improved by 53.2 in the PLF group and 56.7 in 13 the TLIF group. Carreon et al, 18 reported that the TLIF group made significantly greater improvements in ODI (21.1 in the PLF group vs. 30.4 in the TLIF group; p=0.001). 17 Ghasemi 2016, in a retrospective cohort study, reported that at 24 months follow-up, TLIF patients had significantly less disability as measured by ODI (p <0.05).…”

Section: Discussionmentioning

confidence: 97%

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Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

2020

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Background: Spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. Both posterolateral fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) and have shown high fusion rates with good clinical outcomes. But it is not clear which treatment leads to better outcomes, as limited studies have been done to compare PLF and TLIF in low grade spondylolisthesis. Our objective is to determine whether PLF or TLIF was associated with better clinical and radiological outcomes in patients with low grade spondylolisthesis.Methods: Fourty patients were enrolled and assigned into PLF (n=20) or TLIF (n=20) group. The outcome measures were: clinical outcomes as assessed with a visual analogue scale and the modified Oswestry disability index, the fusion rate based on radiographs.Results: The improvement of visual analog score (VAS) of low back pain was greater in TLIF than in PLF (89.6% versus 88.7%, p=0.79). The improvement of VAS of leg pain was greater in TLIF than in PLF (96.5% versus 94.8%; p=0.27). The improvement of Oswestry disability index (ODI) was greater in TLIF than in PLF (71.7% vs 69.8%, p=0.32). The fusion rate was 85% in TLIF and 75% in PLF (p=0.43). Overall outcome was excellent in 80% in TLIF compared to 65% in PLF (p=0.29).Conclusions: Fusion rates are higher in TLIF and average functional outcomes (VAS and ODI) were better in TLIF compared to PLF. Larger and longer studies may provide a significant outcome. Based on our results and literature review, we conclude that TLIF is superior to PLF.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

2020

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“…35 In an observational study, Carreon et al also compared the clinical improvement in 101 patients with these techniques and the results suggested that visual analog scale scores for back and leg pains improved by 4.2 and 4.6 respectively for TLIF group and 3.5 and 3.7 for PLF group. 36 TLIF exhibited a significantly higher incidence of adjacent segment disease. Fixing intervertebral cages or grafts can increase stress on adjacent sections by increasing segmental rigidity, subsequently accelerating the degenerative process of adjacent segments after surgery.…”

Section: Discussionmentioning

confidence: 88%

Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters

Farrokhi

Eghbal

Mousavi

et al. 2021

Indian Journal of Neurotrauma

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Objective This retrospective study aims to compare the clinical and radiological outcomes of posterolateral fusion (PLF) with transforaminal lumbar interbody fusion (TLIF + PLF) for the treatment of patients with low-grade spondylolisthesis. Methodology A total of 77 adult patients ≥18 years with low-grade spondylolisthesis, Meyerding grades I and II, were assigned into two groups: 36 patients treated with PLF and 41 patients treated with TLIF + PLF. The PLF group is composed of the patients that were operated with pedicle screw and the TLIF + PLF group is composed of the ones that were operated with fixation and TILF by autografting. Clinical evaluation was performed using the spino-pelvic sagittal balance, Numeric Rating Scale, Oswestry Disability Index, blood loss, operation times, and postoperative hospital stay of the PLF vs TLIF groups. The incidences of postoperative low back pain and radicular pain in the two groups were also recorded. Radiography was performed preoperatively and postoperatively to assess spino-pelvic parameters. Results Significant restoration of spino-pelvic sagittal balance was observed in the TLIF group after surgery, and all spino-pelvic sagittal balance parameters showed significant improvement in the TLIF group after surgery, while in the PLF group, all spino-pelvic sagittal parameters had improved except the segmental angle lordosis (p = 0.316), which showed no significant difference after surgery in the PLF group. Postoperative pelvic incidence and pelvic tilt significantly improved in the TLIF group in comparison to PLF groups. Hence, TLIF can achieve better postoperative spino-pelvic sagittal balance parameters than PLF. There was no difference in the complication rates for each group. Both groups achieved significant improvement in postoperative clinical outcomes, and there was no significant difference in the incidence of postoperative low back pain or radicular pain between the two groups. Conclusion Both surgical procedures PLF and TLIF were effective. PLF and TLIF can result in improved clinical and radiological outcomes for patients treated for low-grade spondylolisthesis. TLIF can achieve better restoration of spino-pelvic sagittal balance parameters than PLF alone.

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“…The investigators found no significant difference in patient-reported outcomes, complications, reoperation rate, gain in QALYs or cost per QALY. Additionally, Carreon et al retrospectively compared 101 PLF patients with 101 TLIF patients [37]. While the authors demonstrated greater improvement in ODI and Short-Form-6D (SF-6D) at 12 months in the TLIF population, it was at the high cost of an additional $4830.…”

Section: Interbody Fusionmentioning

confidence: 99%

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Samuel

Moore

Cunningham

2017

Curr Rev Musculoskelet Med

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There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

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Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N2QOD data

Cited by 29 publications

References 34 publications

Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

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