Transforaminal Lumbar Interbody Fusion versus Posterolateral Fusion for Surgical Treatment of Segmental Lumbar Spinal Instability

Background data: The rationale behind lumbar fusion surgery is to eliminate pathologic segmental motion and its accompanying symptoms, especially low back pain. Posterolateral fusion (PLF) using pedicle screw fi xation has been one of the most popular procedures among the posterior lumbar reconstruction techniques. Lumbar interbody fusion is a recognized surgical technique in treating chronic low back pain in segmental instability. Purpose: The purpose of this study was to compare the clinical and radiological outcomes of stabilizing the lumbar spine using transforaminal lumbar interbody fusion (TLIF) versus PLF for lumbar segmental instability. Study design: A prospective, nonrandomized clinical controlled trial was performed. Patients and methods: A total of 40 patients with segmental lumbar instability were divided into two groups (TLIF and PLF groups), with 20 patients each. Top-loaded pedicle screw construct was used with both groups. The mean age of the patients was 48.35 years in the TLIF group and 45.3 years in the PLF group. Sex distribution was six males and 14 females in the TLIF group and seven males and 13 females in the PLF group. Mechanical low back pain was the chief complaint in all patients.Sciaticawasacomplaintin12(60%)patientsofthe TLIFgroupand13(65%)patientsofthe PLFgroup. Patientswere evaluated preoperatively and postoperatively by visual analog scale (VAS), Oswestry disability index, and radiographs. Results: The average operative time was 214.5 min in the TLIF group and 192.5 min in the PLF group. The mean estimated blood loss was 278 ml in the TLIF group and 259 ml in the PLF group. The average length of hospital stay was 3.85 days in the TLIF group and 3.8 days in the PLF group. Patients progressively improved regarding VAS and Oswestry disability index in both groups, with no statistically signi fi cant difference, except for VAS for back pain, where the TLIF group gave better results. However, the TLIF group gave better results in patients with postlaminectomy instability than the PLF group. Solid fusion occurred in 17 (85%) patients of the TLIF group and 16 (80%) patients of the PLF group, with no statistical difference. Conclusion: Both TLIF and PLF are effective and safe options for treating segmental lumbar instability. However, interbody fusion yields superior results in patients with postlaminectomy instability (2021ESJ253).