Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches

Chad D Cole, Todd D McCall, Meic H Schmidt, Andrew T Dailey, Chad D Cole, Todd D McCall, Meic H Schmidt, Andrew T Dailey

Abstract

The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw-rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

Figures

Fig. 1
Fig. 1
Schematic representation of lumbar spine demonstrating the area of bony removal and route of access to the intervertebral body space. (Top) Medial box represents area and access for the PLIF procedure; (bottom) lateral box represents area and access for the TLIF procedure
Fig. 2
Fig. 2
Schematic representation of lumbar spine demonstrating the angle of interbody graft insertion for the PLIF procedure (top, medial) and TLIF procedure (bottom, lateral)

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