Posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis: a systematic review and meta-analysis

Levin, Jay M.; Tanenbaum, Joseph E.; Steinmetz, Michael P.; Mroz, Thomas E.; Overley, Samuel C.

doi:10.1016/j.spinee.2018.01.028

Cited by 79 publications

(79 citation statements)

References 26 publications

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“…16 Levin et al 2018, in their meta-analysis of 2 RCT's and 5 cohort studies, reported that the pooled fusion success rate was 84.7% in the PLF group and 94.3% in the TLIF group. 20 In our study, we observed 75% (15/20) fusion rate in PLF and 85% (17/20) fusion rate in TLIF. Our result is consistent with the recent available studies.…”

Section: Discussionsupporting

confidence: 53%

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: 53%

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

2020

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“…Over the past several years, a gradual shift has been made toward lumbar fusion approaches that are less invasive and theoretically protective of the thecal sac and nerve roots. Several authors have reported on their experiences of operative and perioperative (30-day) safety via a transforaminal lumbar interbody fusion (TLIF) approach [1][2][3][4][5][6], and more recently, studies examining the safety of outpatient lumbar fusion are on the rise [7][8][9][10][11][12][13][14][15][16]. Depending on the study, complications can be significantly under-reported.…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

Schlesinger¹,

Krugman²,

Abbott

et al. 2020

Cureus

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We sought to evaluate differences in perioperative baseline characteristics, operative efficiency, and 30-day safety events for patients undergoing standalone minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) in a hospital versus an ambulatory surgery center (ASC). Methods Patients were retrospectively identified and sequentially enrolled from the office records of a single, community neurosurgeon. Records for the first 50 qualifying patients in the hospital and ASC cohorts were retrieved. Variables collected included: baseline demographic and health status, operative safety (intra-op complications) and efficiency (operative time, fluoroscopy time, etc.), and 30-day post-operative safety (emergency room visits, re-admission, and re-operation). Results At baseline, hospital and ASC patients were equivalent in gender distribution, BMI, and pre-operative narcotic use. Statistically significant differences were found in age and comorbidity burden (ASA status and Charleson Comorbidity Index); p < 0.0001, p = 0.0039, and p < 0.001 respectively. The only significant difference in construct type between hospital and ASC patients was the proportion of one-versus two-level fusions; all two-level fusions were performed in the hospital group. There were no differences in operative time, need for transfusions, or iatrogenic complications. There were also no differences between the groups in 30-day events of ER visits, re-admission, re-operation, or post-operative narcotic refill use. The length of stay was significantly different between the ASC and hospital settings (p < 0.0001). Conclusions As expected, ASC patients were younger and relatively healthier compared to their hospital counterparts. Thirty-day safety events of ER visits, re-admission, re-operation, and narcotic refill utilization were representative of population norms. Patients with standalone, expandable MIS-TLIF underwent efficient operative procedures and experienced minimal 30-day complications independent of their operative status. ASC patients had the added benefit of significantly reduced length of stay over their hospital counterparts. Given the equivalency of the 30-day post-operative course for both patient cohorts, a substantial reduction in economic burden is likely for the ASC patients.

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“…The overall confidence in the results of the 28 reviews was rated as “low” in 2 SRs 9 , 10 and “critically low” in the rest 11 - 36 ( Table 3 ). Critical appraisal of each SR is found in Table S2 in the supplemental material.…”

Section: Resultsmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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Study Design: A systematic cross-sectional survey of systematic reviews (SRs). Objective: To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. Methods: We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. Results: We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated “low” in 2 SRs and “critically low” in 26. Conclusions: The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is “critically low.”

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Posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis: a systematic review and meta-analysis

Cited by 79 publications

References 26 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

Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

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