Clinico-radiological outcomes of single level TLIF using local morselized impacted bone graft vs cage with local bone graft

Abstract

Aim: To study the fusion rate and clinical outcome of transforaminal lumbar interbody fusion (TLIF) with cage and TLIF with local morselized graft. Design: Retrospective. Materials and Methods: We retrospectively studied thirty patients who received the TLIF with local morselized impacted bone grafts without a cage (Group 1), thirty patients who received TLIF with local bone graft combined with one titanium cage with 4° lordosis (Group 2) with an average follow-up of 15 months. Patients were clinically evaluated at regular intervals along with radiographs. Computed tomography (CT) scans were also performed at 6 months and 1 year after surgery. Functional outcome was assessed using the Modified Oswestry Score (MOS) and Visual Analog Score (VAS) for back pain preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year. Statistical Analysis Used:P < 0.05 was taken as the level of significance. SPSS software version 17 was used for analysis. Results: The VAS scores in group 2 (TLIF with cage group) at preoperatively, 3 months, 6 months, and at the end of 1 year improved significantly from 8.47, 3.53, 2.27, and 1.60, respectively; in TLIF without cage group (Group 1), it improved from 8.73, 4.00, 2.53, and 1.47, respectively. The MOS improved from 75.87 preoperatively in the TLIF with cage group (Group 2) to 34.53 at the end of 1 year. In the TLIF without cage group (Group 1), it improved from the preoperative P value of 75.47 to 35.30. Fusion was present in all the cases radiologically. Brantigan criteria were used to assess fusion on CT scan. The mean lordotic angle in the cage group decreased from 17.3° immediately after surgery to 16.5° at 1 year. The mean change was 0.80° in Group 1 (no cage), and the mean lordotic angle decreased from 16.5° immediately after surgery to 14.4° in group 2 (with cage) at 1 year. Conclusion: If we compare clinical and radiological results between the local bone graft with a cage and the morselized impacted bone graft groups, for one-level TLIF, the difference is not significant.