J Korean Neurosurg Soc.  2014 Dec;56(6):469-474. 10.3340/jkns.2014.56.6.469.

Comparison of Transforaminal Lumbar Interbody Fusion with Direct Lumbar Interbody Fusion: Clinical and Radiological Results

• Lee YS
• Kim YB
• Park SW
• Chung C

• KMID: 2191133
• DOI: http://doi.org/10.3340/jkns.2014.56.6.469

Abstract

OBJECTIVE
The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes.
METHODS
A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed.
RESULTS
DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p<0.001). As the extent of surgical level increased, DLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05).
CONCLUSION
Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach.

Keyword

Transforaminal lumbar interbody fusion; Direct lumbar interbody fusion; Segmental balance; Coronal balance; Fusion rate

MeSH Terms

Animals
Humans
Length of Stay
Lordosis
Medical Records
Operative Time
Retrospective Studies
Visual Analog Scale

Figure

• 

  Fig. 1 Postoperative radiographs of the transforaminal lumbar interbody fusion (A) and direct lumbar interbody fusion (B) groups.

Reference

1. Acosta FL, Liu J, Slimack N, Moller D, Fessler R, Koski T. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults : a radiographic study. J Neurosurg Spine. 2011; 15:92–96. PMID: 21476802.

2. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine (Phila Pa 1976). 1993; 18:2227–2230. PMID: 8278837.

3. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976). 1995; 20:1410–1418. PMID: 7676341.

4. Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY. An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. J Neurosurg Spine. 2011; 15:11–18. PMID: 21476801.

5. Cutler AR, Siddiqui S, Mohan AL, Hillard VH, Cerabona F, Das K. Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine. 2006; 5:534–539. PMID: 17176018.

6. Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus. 2010; 28:E8. PMID: 20192668.

7. Glassman SD, Carreon L, Djurasovic M, Campbell MJ, Puno RM, Johnson JR, et al. Posterolateral lumbar spine fusion with INFUSE bone graft. Spine J. 2007; 7:44–49. PMID: 17197332.

8. Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U. Transforaminal lumbar interbody fusion : a safe technique with satisfactory three to five year results. Eur Spine J. 2005; 14:551–558. PMID: 15672243.

9. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses : dorsal traction-reposition and anterior fusion (authors transl). Z Orthop Ihre Grenzgeb. 1982; 120:343–347. PMID: 7113376.

10. Houten JK, Alexandre LC, Nasser R, Wollowick AL. Nerve injury during the transpsoas approach for lumbar fusion. J Neurosurg Spine. 2011; 15:280–284. PMID: 21619401.

11. Houten JK, Post NH, Dryer JW, Errico TJ. Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus. 2006; 20:E8. PMID: 16599424.

12. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis : perioperative outcomes and complications. Spine (Phila Pa 1976). 2010; 35(26 Suppl):S322–S330. PMID: 21160396.

13. Jiang SD, Chen JW, Jiang LS. Which procedure is better for lumbar interbody fusion : anterior lumbar interbody fusion or transforaminal lumbar interbody fusion? Arch Orthop Trauma Surg. 2012; 132:1259–1266. PMID: 22622795.

14. Johnson RD, Valore A, Villaminar A, Comisso M, Balsano M. Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease. J Clin Neurosci. 2013; 20:576–581. PMID: 23375396.

15. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976). 1996; 21:941–944. PMID: 8726197.

16. Kawaguchi Y, Yabuki S, Styf J, Olmarker K, Rydevik B, Matsui H, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976). 1996; 21:2683–2688. PMID: 8961456.

17. Kepler CK, Huang RC, Sharma AK, Meredith DS, Metitiri O, Sama AA, et al. Factors influencing segmental lumbar lordosis after lateral trans psoas interbody fusion. Orthop Surg. 2012; 4:71–75. PMID: 22615150.

18. Kepler CK, Sharma AK, Huang RC, Meredith DS, Girardi FP, Cammisa FP Jr, et al. Indirect foraminal decompression after lateral transpsoas interbody fusion. J Neurosurg Spine. 2012; 16:329–333. PMID: 22284229.

19. Knight RQ, Schwaegler P, Hanscom D, Roh J. Direct lateral lumbar interbody fusion for degenerative conditions : early complication profile. J Spinal Disord Tech. 2009; 22:34–37. PMID: 19190432.

20. Le TV, Burkett CJ, Deukmedjian AR, Uribe JS. Postoperative lumbar plexus injury after lumbar retroperitoneal transpsoas minimally invasive lateral interbody fusion. Spine (Phila Pa 1976). 2013; 38:E13–E20. PMID: 23073358.

21. Lee CS, Hwang CJ, Lee DH, Kim YT, Lee HS. Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach : a systematic review of randomized trials. Clin Orthop Surg. 2011; 3:39–47. PMID: 21369477.

22. McAfee PC, Regan JJ, Geis WP, Fedder IL. Minimally invasive anterior retroperitoneal approach to the lumbar spine. Emphasis on the lateral BAK. Spine (Phila Pa 1976). 1998; 23:1476–1484. PMID: 9670400.

23. Oliveira L, Marchi L, Coutinho E, Pimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976). 2010; 35:S331–S337. PMID: 21160397.

24. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006; 6:435–443. PMID: 16825052.

25. Park JS, Kim YB, Hong HJ, Hwang SN. Comparison between posterior and transforaminal approaches for lumbar interbody fusion. J Korean Neurosurg Soc. 2005; 37:340–344.

26. Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW Jr, Kuklo TR. Transforaminal lumbar interbody fusion : clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech. 2005; 18:337–346. PMID: 16021015.

27. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB. Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg. 1999; 91(1 Suppl):60–64. PMID: 10419370.

28. Sasso RC, Kenneth Burkus J, LeHuec JC. Retrograde ejaculation after anterior lumbar interbody fusion transperitoneal versus retroperitoneal exposure. Spine (Phila Pa 1976). 2003; 28:1023–1026. PMID: 12768143.

29. Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion : a meta-analysis based on the current evidence. Eur Spine J. 2013; 22:1741–1749. PMID: 23572345.

30. Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus. 2010; 28:E7. PMID: 20192667.

31. Zhou ZJ, Zhao FD, Fang XQ, Zhao X, Fan SW. Meta-analysis of instrumented posterior interbody fusion versus instrumented posterolateral fusion in the lumbar spine. J Neurosurg Spine. 2011; 15:295–310. PMID: 21619404.