Turkish Neurosurgery 2024 , Vol 34 , Num 2
Radiological and Clinical Outcomes of Transforaminal vs. Posterior Lumbar Interbody Fusions: A Systematic Review
1Islamic Azad University, Tehran Medical Sciences, Farhikhtegan Hospital, Department of Neurosurgery, Tehran, Iran
2Islamic Azad University, Tehran Medical Sciences, Bouali Research Center, Tehran, Iran
3Landstuhl Regional Medical Center, Division of Neurosurgery, Landstuhl, Germany
4Sheffield Teaching Hospitals National Health Service Foundation Trust, Department of Neurosurgery, Sheffield, UK
DOI : 10.5137/1019-5149.JTN.42926-22.2 AIM: To compare 1 and 2 level posterior lumbar interbody fusion (PLIF) to transforaminal lumbar interbody fusion (TLIF) techniques in an effort to elucidate trends in overall radiological and clinical outcome, rate of complications, operation time, length of hospital stay, reoperation rate, pseudoarthrosis or failure rate, and estimated blood loss.

MATERIAL and METHODS: Online databases including Scopus, Science Direct, Clinical key, Ovid, Embase, and PubMed/ Medline were queried over the period encompassing January 2000 to August 2021 for suitable studies. Search criteria consisted of (?TLIF? AND ?PLIF?) OR (?Transforaminal Lumbar interbody fusion? AND ?Posterior lumbar interbody fusion?) AND (?comparative? OR ?comparison?) OR (?fusion? OR ?outcome? Or ?reoperation? OR ?Failure rate? OR ?Failure? OR ?Complication rate? OR ?Complication?).

RESULTS: Fourteen eligible studies were selected. Neurological deficits were considerably higher in the PLIF group (24%vs.10%). The mean operation time and estimated blood loss for PLIF and TLIF were 178.5 min and 515 ml; and 160 min and 405 ml, respectively. No significant difference was found regarding the fusion rate. The reoperation rate was greater in PLIF (2%) than TLIF (0%). No clear difference was found regarding the length of stay (LOS) and surgical site infection (SSI).

CONCLUSION: The superiority of TLIF over PLIF may be evidenced by the lower rate of neurologic deficit, surgical technical aspects, less blood loss and shorter operation time. Cage migration, screw displacement, infection, and pseudoarthrosis may be influenced by a variety of factors, including the facility, the surgeon, and the instrumentation/ graft used, and do not appear to be different. Multicenter non-randomized prospective trials are recommended to determine the possible superiority of one method over the other. Keywords : Transforaminal lumbar interbody fusion, Posterior lumbar interbody fusion, Complications, Fusion rate, Outcome

Corresponding author : Payman VAHEDI, Payman.vahedi@gmail.com