Clinical outcomes and sagittal alignment of single-level unilateral instrumented transforaminal lumbar interbody fusion with a 4 to 5-year follow-up

Abstract

Purpose: A retrospective study was designed to evaluate clinical outcomes and sagittal alignment following single-level unilateral instrumented transforaminal lumbar interbody fusion (TLIF).

Methods: From November 2008 to December 2010, a total of 139 patients, who suffered from single-level lumbar degenerative disease, were included in this study. Forty-seven males and seventy-two females with a mean age of 57.3 years were enrolled. The average follow-up period was 51.7 months with a range of 41-66 months. The follow-up rate was 85.6 %. Thirty-one patients had diagnosis of discogenic low back pain, ten had recurrent disk herniation, thirty-four had spinal stenosis, and fourty-four had spondylolisthesis. Clinical outcomes were evaluated using the Oswestry disability index (ODI), visual analog scale (VAS) and Japanese Orthopedic Association. Operating time, blood loss, length of stay, and complications were also evaluated. The sagittal alignment and fusion status were assessed by X-ray and three-dimensional computed tomography.

Results: The average operating time was 92.1 ± 27.5 min, the average blood loss was 135.1 ± 113.5 ml, and the average length of stay was 12.0 ± 2.9 days. The overall complication rate was 13.4 %, and the fusion rate was 82.4 %. The postoperative clinical outcomes and sagittal alignment were significantly different from the preoperative values. The final lumbar lordosis angle and segment lordosis angle were associated with back pain VAS and ODI scores, respectively.

Conclusion: Unilateral instrumented TLIF is a safe and effective treatment option for single-level lumbar degenerative disease, and is less invasive, yields good outcomes and has a low complication rate. In addition, the procedure has the potential to partly restore sagittal alignment.

Keywords: Clinical outcomes; Lumbar degenerative diseases; Sagittal alignment; Transforaminal lumbar interbody fusion; Unilateral instrumentation.