Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters

Abstract

Objective This retrospective study aims to compare the clinical and radiological outcomes of posterolateral fusion (PLF) with transforaminal lumbar interbody fusion (TLIF + PLF) for the treatment of patients with low-grade spondylolisthesis. Methodology A total of 77 adult patients ≥18 years with low-grade spondylolisthesis, Meyerding grades I and II, were assigned into two groups: 36 patients treated with PLF and 41 patients treated with TLIF + PLF. The PLF group is composed of the patients that were operated with pedicle screw and the TLIF + PLF group is composed of the ones that were operated with fixation and TILF by autografting. Clinical evaluation was performed using the spino-pelvic sagittal balance, Numeric Rating Scale, Oswestry Disability Index, blood loss, operation times, and postoperative hospital stay of the PLF vs TLIF groups. The incidences of postoperative low back pain and radicular pain in the two groups were also recorded. Radiography was performed preoperatively and postoperatively to assess spino-pelvic parameters. Results Significant restoration of spino-pelvic sagittal balance was observed in the TLIF group after surgery, and all spino-pelvic sagittal balance parameters showed significant improvement in the TLIF group after surgery, while in the PLF group, all spino-pelvic sagittal parameters had improved except the segmental angle lordosis (p = 0.316), which showed no significant difference after surgery in the PLF group. Postoperative pelvic incidence and pelvic tilt significantly improved in the TLIF group in comparison to PLF groups. Hence, TLIF can achieve better postoperative spino-pelvic sagittal balance parameters than PLF. There was no difference in the complication rates for each group. Both groups achieved significant improvement in postoperative clinical outcomes, and there was no significant difference in the incidence of postoperative low back pain or radicular pain between the two groups. Conclusion Both surgical procedures PLF and TLIF were effective. PLF and TLIF can result in improved clinical and radiological outcomes for patients treated for low-grade spondylolisthesis. TLIF can achieve better restoration of spino-pelvic sagittal balance parameters than PLF alone.

Comparative Study on the Effectiveness of Posterolateral Fusion vs. Interbody Fusion in Isthmic/Degenerative Spondylolisthesis

“…Yadav et al (2020) showed comparable results that TLIF surgical procedure was found better than PLF regarding back pain and the results were found statistically significant (P<0.001). A similar scenario was also reported in a study carried out by Farrokhi et al, 17 who confirmed that the TLIF technique was found better than PLF regarding pain with statistically significant results (P = 0.0001). Farid and Elkholy 25 exhibited similar outcomes according to the VAS score, patients treated with the TLIF technique had more relief in pain than the PLF group and the results were statistically significant.…”

“…However, Yadav et al, 26 reported that in the PLF group, the mean age of the patients was 47 years while in the TLIF group was 48 years. Farrokhi et al, 17 highlighted that in the PLF group, the mean age of the patients was 55 years while in the TLIF group, the mean age of patients was 52 years.…”

“…During the last decades, posterolateral fusion 15 and transforaminal lumbar interbody fusion 16 have turned into the most common methods which can stable the lumbar vertebra and successfully enhance performance scores after surgery. 17 Though the attractiveness of every method is arguable, therefore the present study is carried out to compare the effectiveness of posterolateral fusion vs. TLIF in isthmic/degenerative spondylolisthesis. Despite the significant amount of innovative fusion procedures that are accessible, numerous studies highlight that the most naive technique, PLF in situ, is merely as effectual as more latest techniques and causes fewer complications.…”

Spinopelvic Parameters in the Clinical and Functional Outcomes of Patients Submitted to Lumbar Interbody Fusion Surgery – A Prospective Study

“…The positive effect of TLIF surgery in pain control and improvement in quality of life is also supported by other studies. 17 Regarding variables related to patient characteristics, only BMI ! 30 Kg/m 2 influenced the functional outcome, as obese patients had higher degree of disability at M6.…”

“…The positive effect of TLIF surgery in pain control and improvement in quality of life is also supported by other studies. 17…”