Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results

Abstract

The unilateral transforaminal approach for lumbar interbody fusion as an alternative to the anterior (ALIF) and traditional posterior lumbar interbody fusion (PLIF) combined with pedicle screw instrumentation is gaining in popularity. At present, a prospective study using a standardized tool for outcome measurement after the transforaminal lumber interbody fusion (TLIF) with a follow-up of at least 3 years is not available in the current literature, although there have been reports on specific complications and cost efficiency. Therefore, a study of TLIF was undertaken. Fifty-two consecutive patients with a minimum follow-up of 3 years were included, with the mean follow-up being 46 months (36--64). The indications were 22 isthmic spondylolistheses and 30 degenerative disorders of the lumbar spine. Thirty-nine cases were one-level, 11 cases were two-level, and two cases were three-level fusions. The pain and disability status was prospectively evaluated by the Oswestry disability index (ODI) and a visual analog scale (VAS). The status of bony fusion was evaluated by an independent radiologist using anterior-posterior and lateral radiographs. The operation time averaged 173 min for one-level and 238 min for multiple-level fusions. Average blood loss was 485 ml for one-level and 560 ml for multiple-level fusions. There were four serious complications registered: a deep infection, a persistent radiculopathy, a symptomatic contralateral disc herniation and a pseudarthrosis with loosening of the implants. Overall, the pain relief in the VAS and the reduction of the ODI was significant (P<0.05) at follow-up. The fusion rate was 89%. At the latest follow-up, significant differences of the ODI were neither found between isthmic spondylolistheses and degenerative diseases, nor between one- and multiple-level fusions. In conclusion, the TLIF technique has comparable results to other interbody fusions, such as the PLIF and ALIF techniques. The potential advantages of the TLIF technique include avoidance of the anterior approach and reduction of the approach related posterior trauma to the spinal canal.

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

“…Our fusion rate of single-level surgeries compares favorably to those previously reported in the literature for patients undergoing conventional lumbar arthrodesis [7,9,13,15]. On the other hand, the multilevel fusion group revealed a low fusion rate.…”

“…Schwender et al [25] reported an average 32% improvement in the Oswestry Disability Index score postoperatively, with an average followup of 22.6 months. When comparing with traditional open transforaminal lumbar interbody fusion, average improvements in the Oswestry Disability Index score of 43% at 2 years and 24% at the latest followup between 35 and 64 months postoperatively were noted in patients with isthmic spondylolisthesis [9]. The Spine Patient Outcomes Research Trial found a 24% improvement in the Oswestry Disability Index score at 2 years postoperatively in patients with degenerative spondylolisthesis [27].…”

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

“…The pseudarthrosis rate was higher in both of our study groups than usually reported for APF and TLIF techniques [16,24,28,32]. In fact, fusion assessment was based on a very strict and detailed scale resulting in a very critical look at fusion results.…”

“…Because of its posterolateral extracanalar discectomy and fusion, it has been reported as a safe technique, without the potential complications described when using combined APF and PLIF techniques [17,28]. Several authors have published retrospective studies comparing the TLIF technique to APF [16,18,35]. However, these studies included multiple diagnostic groups, and clinical as well as radiological outcomes were not always reported.…”

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

“…In large curves, structural anterior column support provides several benefits, including improved stability, decreased stress on screws, higher fusion rates, and better lumbar lordosis [16,17,26,30,31,39]. Nevertheless, instrumented arthrodesis procedures are not free of complications, and considering all the comorbidities associated with an older population, surgical treatment of degenerative scoliosis should be carefully studied to avoid them.…”