Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability

Najmus Sakeb, Kamrul Ahsan, Najmus Sakeb, Kamrul Ahsan

Abstract

Background: Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011.

Materials and methods: Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab's criteria) were compared.

Results: Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF.

Conclusions: Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.

Keywords: Lumbar instability; posterior lumbar interbody fusion; transforaminal lumbar interbody fusion.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
X-ray lumbosacral spine lateral view showing radiological assessment of structural restoration (Disc height, foraminal height and angle of total lumbar lordosis). Disc height has been measured as (DA+DP) / 2; The foraminal height has been measured as the distance between the midpoint of the superior and inferior neural arch (F1-F2); The angle of total lumbar lordosis has been measured by the angle formed by the perpendicular lines from the two lines drawn along the superior end plate of L1 and superior end plate of S1 (angle ABC)
Figure 2
Figure 2
X-ray lumbosacral spine lateral view showing (a) Measurement of instability according to posner; Dynamic lateral film (flexion) in standing posture showing >10° sagittal rotation (angular displacement); measurement is done by the angle formed between the two adjacent end-plates. (b) Dynamic film in extension. (c) The dynamic films producing anterior translation measured as the distance between a and b= d (in flexion). (d) The distance of a1 and b1 = d1 (in extension). The distance difference (D) in flexion (d) and extension (d1) calculated as the percentage (D = d – d1 above vertebral width ×100) of the width of the above vertebra
Figure 3A
Figure 3A
Degenerative instability managed by PLIF; (a) X-Ray lumbosacral (L/S) spine Anteroposterior view. (b) X-Ray L/S spine lateral view showing degenerative spondylolisthesis at L4 over L5. (c) Dynamic film in flexion showing anterior translation and angular displacement. (d) Dynamic film in extension showing differences in translation and angular motion. (e) T2W MRI scan of that patient with degeneration and spondylolisthesis at L4/5 level.
Figure 3B
Figure 3B
(a) Postoperative X-ray lumbosacral spine anteroposterior view and (b) lateral view showing good implant position. (c) 1 year followup X-ray anteroposterior view and (d) lateral view showing listhesis reduction and radiological fusion (arrow)
Figure 4A
Figure 4A
Spondylolytic instability managed by TLIF: X-ray lumbosacral spine anteroposterior view (a) and lateral view (b) showing grade-I spondylolytic spondylolisthesis instability at L5/S1 level. (c) Dynamic lateral view (flexion) showing spondylolysis (arrow) and anterior translation. (d) Dynamic lateral view (extension) showing spondylolysis (arrow) and angular motion at L5/S1 level. (e) T2W MRI scan of that patient showing involvement of L5/S1 level
Figure 4B
Figure 4B
(a) Postoperative X-ray lumbosacral spine anteroposterior view and (b) lateral view showing good implant position and the transforaminal approach (arrow). (c) 1 year followup X-Ray anteroposterior view and (d) lateral view showing listhesis reduction and radiological fusion (arrow)

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