Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Abstract

Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

Fig. 1

aTLIF inadequate fusion. CT scan at 16-month FU. Fused right facet joint (P1), interbody pseudarthosis (A-5). bTLIF solid fusion. CT scan at 22-month FU. Fused right facet joint (P-1), interbody solid fusion (A-1). cAPF inadequate fusion. CT scan at 33-month FU. L4–L5 posterior nonunion (P-3), interbody nonunion (A-5) L5–S1 posterior solid fusion (P-1), interbody nonunion (A-5). dAPF solid fusion. CT scan at 35-month FU. L4–L5 posterior solid fusion (P-1), interbody solid fusion (A-1). L5–S1 posterior solid fusion (P-1), interbody solid fusion (A-1)