Benefit of Transforaminal Lumbar Interbody Fusion vs Posterolateral Spinal Fusion in Lumbar Spine Disorders

BACKGROUND: Despite increasing use and potential benefits of transforaminal lumbar interbody fusion (TLIF) compared with posterolateral spinal fusion (PSF), previous studies have not documented improved clinical outcomes with TLIF vs PSF. OBJECTIVE: To compare the outcomes of TLIF with PSF in patients with spondylolisthesis, spinal stenosis, and adjacent level disease. METHODS: The National Neurosurgical Quality and Outcomes Database was queried for patients who had a lumbar fusion. Eighty-five percent (1722) of enrolled cases had 12-month follow-up data. There were 306 PSF patients and 1230 TLIF patients. PSF cases within each diagnostic subgroup were propensity-matched to patients who had TLIF. Sufficient propensity-matched controls were available for patients with spondylolisthesis (109), spinal stenosis (63), and adjacent segment disease (47). RESULTS: Operating room time, estimated blood loss, and length of stay were similar between PSF and TLIF in all 3 propensity-matched groups. In the spondylolisthesis group, there was a greater improvement in Oswestry Disability Index (ODI) with TLIF vs PSF at 3 months (19.4 vs 26.0, P = .009), 12 months (20.8 vs 29.3, P = .001), and in percentage reaching minimal clinically important difference at 12 months (80% vs 62%, P = .007). There were no differences in ODI improvement between PSF and TLIF in the stenosis or adjacent segment disease groups. CONCLUSION: TLIF generated more favorable ODI outcomes than PSF for patients with spondylolisthesis, but not for patients with spinal stenosis or adjacent segment disease. There was also equivalence in operating room time and estimated blood loss between TLIF and PSF, potentially altering the long-standing assumption that PSF is a simpler procedure. ABBREVIATIONS: ASA, American Society of AnesthesiologistsEBL, estimated blood lossEQ-5D, EuroQOL-5DHRQOL, health-related quality of lifeMCID, minimal clinically important differenceNQOD, National Neurosurgery Quality and Outcomes DatabaseNRS, numeric rating scaleODI, Oswestry Disability IndexOR, operating roomPSF, posterolateral spinal fusionTLIF, transforaminal lumbar interbody fusion.