Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other

Background: Various surgical procedures have been recommended for the treatment of degenerative spondylolisthesis,but Controversy still exists regarding the optimal surgical technique . In this study,we compared the clinical and radiologic outcome of the Transforaminal lumbar interbody fusion(TLIF) method with the Instrumented Posterolateral fusion(PLF) in these patients.

Methods: The study population in this retrospective study consisted of 145 consecutive patients of degenerative spondylolisthesis who had undergone lumbar fusion in our institute between September 2010 and October 2013. The patients were divided into two treatment groups, where either instrumented PLF with pedicle screw(180° fusion) or TLIF procedure(360° fusion) was done. The follow-up was performed clinically using the Oswestry Disability Index (ODI), visual analogue scale (VAS)and global outcome. Outcome scores were assessed at 3, 6, 12, and 24 months after surgery. Radiographs were obtained postoperatively and at regular intervals for 24 months. Perioperative outcomes such as surgery time, blood loss, length of hospital stay and incidence of surgical complications were also recorded.

Results: 80 patients underwent TLIF procedure and 65 patients were included in the instrumented PLF group. There were no significant differences between the groups with respect to age,gender,Body Mass Index,smoking and comorbid conditions(p>0.05). No significant difference existed in Pre-operative VAS for back pain,VAS for leg pain and ODI between the two groups(p>0.05). There were no significant group differences in the operation level,hospital stay and surgical complications(all p>0.05). Blood loss, operation time and fusion success rate were significantly greater in the TLIF group than in the PLF group (all P<0.05). Significant differences between groups concerning VAS for back pain,ODI and Global outcome were present at final follow-up. There was no significant difference between the two groups with respect to VAS for leg pain.

Conclusion: Our study showed that TLIF is superior to PLF with respect to functional outcome and fusion rate.