Radiological and Clinical Comparison of Posterolateral Fusion and Transforaminal Interbody Fusion Techniques in Degenerative Lumbar Stenosis

Abstract

Fusion surgery for lumbar degenerative stenosis is an established treatment mode. Despite comparable patient-related outcomes and radiologic results, the necessity of adding interbody fusion to posterolateral fusion remains controversial. We aimed to compare the clinical and radiologic outcomes of posterolateral fusion and transforaminal interbody fusion techniques in degenerative lumbar stenosis with or without spondylolisthesis. We retrospectively evaluated the clinical and radiologic outcomes of 48 patients who underwent decompression plus either posterolateral fusion (PLF; n=23) or transforaminal interbody fusion (TLIF) plus PLF (TLIF+PLF; n= 25) procedures, which incorporated 71 segments for degenerative lumbar stenosis with or without spondylolisthesis. The median follow-up duration for the PLF and TLIF groups were 26 and 31 months, respectively. Both procedures significantly improved the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores; however, the postoperative ODI and VAS scores were unaffected by the procedure type. Postoperative disc heights and percent changes in disc heights did not change by operation type; however, the percent change in the foramen areas was significantly greater in the TLIF group. The addition of TLIF to the PLF procedure resulted in significantly longer operating time and more intraoperative blood loss. Cerebrospinal fluid fistula was the only major complication noted. The radiologic fusion rates were similar between both study groups. Both PLF and TLIF+PLF procedures were effective in ameliorating the symptoms of degenerative lumbar stenosis and spondylolisthesis. Although some radiologic parameters favor TLIF, this was not reflected in the clinical outcomes.