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Characteristics of patients undergoing posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) procedures for spinal fusion following primary lumbar discectomy.
Source publication
Objective:
To compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF) for spinal fusion in patients previously treated by discectomy.
Methods:
This retrospective study evaluated pre- and postoperative neurological status via Japan Orthopaedic Association (JOA) score. Surgical outcome was based on recov...
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Purpose
Epidural anesthesia (EA) is the main anesthesia method for transforaminal percutaneous endoscopic lumbar discectomy (PELD). Reducing the concentration of ropivacaine can help preserve tactile sensation, allowing patients to provide timely feedback to the surgeons when a nerve root is contacted to avoid nerve injury. Therefore, a 90% effecti...
Citations
... Conventional surgical methods, such as posterior approach lumbar interbody fusion and modified transforaminal lumbar interbody fusion, often result in substantial damage to posterior spinal anatomy, significant blood loss, prolonged intraoperative nerve stretching, and extended postoperative bed rest. These factors can lead to complications and adversely impact patient outcomes [8][9][10]. In contrast, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has gained popularity due to its minimal invasiveness and shorter recovery time [11]. ...
Objective
This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making.
Methods
We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay.
Results
① Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients—493 in the Endo-TLIF group and 522 in the MIS-TLIF group. ② Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = − 76.75, 95% CI − 111.59, − 41.90, P < 0.0001), a shorter hospital stay (MD = − 2.15, 95% CI − 2.95, − 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = − 1.12, 95% CI − 1.53, − 0.71, P < 0.00001) compared to the MIS-TLIF group.
Conclusion
Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.
... However, in the fusion group was adjacent segment disease or implant removal Fusion surgery options include instrumented posterolateral fusion (PLF), PLIF, transforaminal lumbar interbody fusion (TLIF), lateral lumbar interbody fusion (LLIF), and anterior lumbar interbody fusion (ALIF). [14][15][16][17] There are very few studies comparing these different options in rLDH. In a retrospective study by Li et al., ALIF, LLIF, and TLIF/PLIF were compared in total of 2625 patients operated for rLDH. ...
... However, the operative time and the incidence of dural tears were lower in the TLIF group. [14] In another prospective randomized study on 45 participants, discectomy, TLIF, and PLF were compared. They concluded that back pain scores were better and risk of dural tears was lower in fusion groups compared to the revision discectomy group. ...
Recurrent lumbar disk herniations (rLDHs) are becoming a common occurrence in present times. However, the optimal surgical strategy for their management is a not clear with discectomy alone and discectomy followed by fusion emerging as the main surgical options. In this editorial debate, we discuss why discectomy and fusion is better option for the management of such cases. The complication rates, treatment satisfaction rates, visual analog scale (VAS) leg pain scores, and rates of adjacent segment disease (ASD) requiring surgery are similar in both the groups. However, the back pain score and reoperation rates are better in fusion surgeries. Moreover, the problems needing reoperations (hardware problems and ASD) in fusion group are easier to treat. Fusion surgery is already indicated in rLDH cases with deformity, instability, and significant axial low back pain. We believe it should be considered in all cases due to negligible risk of recurrence, addressing the iatrogenic spinal instability caused due to extensive bony work, ease of surgery due to more working space, and better restoration of disk height and sagittal balance.
... 4 When traditional open surgery was used for the treatment of patients with LDH, the operative incision needed to be lengthened, which may result in greater surgical trauma, as well as increased bleeding and infection risk. 5,6 Spinal stability was also reduced after lumbar laminectomy. These increased surgery traumas have a greater influence on middle-aged and older patients. ...
Objective
To evaluate the early clinical effect of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in the treatment of middle-aged and elderly patients with single-level lumbar disc herniation accompanied by lumbar instability.
Methods
From January 2019 to June 2020, a total of 82 consecutive patients were categorised into PE-TLIF group and MIS-TLIF group based on different surgical methods. The visual analog scale (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, perioperative objective serological index, operation time, intraoperative blood loss, time to back to work or normal life, and Modified MacNab score were used as the evaluation indexes. The differences between the two groups were analyzed and the clinical effects were compared.
Results
The VAS back pain of PE-TLIF group was decreased compared to that of MIS-TLIF group in the postoperative 1 week and 1 month. The operative time in PE-TLIF group was obviously longer than that in MIS-TLIF group. The hospital stay was significantly shorter in PE-TLIF group than that in MIS-TLIF group. More intraoperative blood loss and postoperative drainage were recorded in MIS-TLIF group. Compared with MIS-TLIF, PE-TLIF surgery was associated with a shorter time to ambulation after surgery and a shorter time to back to work or normal life. Significant statistical differences were observed in IL-6, CRP, and CK on postoperative 3 days between the two groups.
Conclusion
For middle-aged and elderly patients, PE-TLIF and MIS-TLIF surgery both have obvious clinical efficacy and safety. However, with less intraoperative blood loss, shorter recovery time and less injury to the patients, people undergoing PE-TLIF surgery can return to work or normal life faster. It is speculated that PE-TLIF has a higher incidence of complications and recurrence rate than that MIS-TLIF. PE-TLIF may be a better choice for middle-aged and elderly patients with single-level lumbar disc herniation.
... Finally, 17 studies were included in our meta-analysis [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. One was RCT [15]; one was prospective cohort study [12]; others were retrospective studies. ...
Background
To explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.Methods
We searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).Conclusions
This meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.
... Many systematic reviews, meta-analysis, prospective, and retrospective studies were conducted in an attempt to compare the clinical and radiographic outcomes of TLIF and PLIF for the treatment of spondylolisthesis [3], [10], [11], [12], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. Unfortunately, there was no study comparing them in terms of their costs. ...
... In regard to the patients' outcome satisfaction, 86.7% of the TLIF patients in this study reported either excellent or good outcomes compared to only 80% of the PLIF group. Other studies from higherincome nations reported excellent or good outcomes in 79-88.9% of their TLIF patients and 74-92.3% of PLIF patients [11], [22], [23], [24], [25], [27]. ...
... In terms of complications, nerve root injury occurred in 6.7% of the PLIF patients versus none in the TLIF group. In our literature review, this rate was 0-13.6% in the PLIF patients and 0-5.6% in the TLIF patients [10], [11], [14], [16], [17], [18], [19], [21], [22], [23], [24], [25], [26], [27]. About 6.7% of each group of this study developed intraoperative dural tear which is a similar rate to that was reported in the literature from higher-income nations which range from 0% to 23.1% of the PLIF patients and from 0 to 10.4% of the TLIF patients [10], [11], [14], [15], [16], [17], [18], [19], [22], [23], [24], [26], [27]. ...
BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials. AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes. METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations. RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed improvement in the TLIF group more than the PLIF group but with no significant difference. The mean operative time was significantly longer in the PLIF (p < 0.05), also, the blood loss was significantly less in the TLIF (p < 0.001). The complications frequency did not show any statistical significance between both groups and no significant difference in the patient’s post-operative patient satisfaction (p = 0.6). The mean hospital stay was non-significantly longer in the PLIF (p = 0.7). At 12-month follow-up, 93.3% of the TLIF patients were fused versus 86.7% of the PLIF (p = 0.5). The total cost of the TLIF was significantly less (p < 0.001). CONCLUSION: Both PLIF and TLIF could achieve similar fusion rates and clinical satisfaction in the management of lumbar spondylolisthesis. The TLIF group was significantly better in terms of financial burden, operative time, and blood loss.
... A study using correlation analysis reported that the degree of back pain correlates with the pain, walking function, and social life domains of the JOABPEQ. Therefore, studies using the JOABPEQ focus primarily on comparative testing and correlation analysis for the degree of back pain [5,6]. However, no study has investigated whether the 25 items of the JOABPEQ can explain the degree of lower limb symptoms in patients with low back pain-related diseases. ...
The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was created to evaluate specific treatment outcomes in terms of physical functioning, social ability, and mental health in patients with back pain-related diseases. In this study, we investigated whether the JOABPEQ could be used to construct a regression model to quantify low back pain and lower limb symptoms in patients with lumbar disc herniation (LDH). We reviewed 114 patients with LDH scheduled to undergo surgery at our hospital. We measured the degrees of 1) lower back pain, 2) lower limb pain, and 3) lower limb numbness using the visual analog scale before the surgery. All answers and physical function data were subjected to partial least squares regression analysis. The degrees of lower back and lower limb pain could be used as a regression model from the JOABPEQ and had a significant causal relationship with them. However, the degree of lower limb numbness could not be used for the same. Based on our results, the questions of the JOABPEQ can be used to multilaterally understand the degree of lower back pain and lower limb pain in patients with LDH. However, the degree of lower limb numbness has no causal relationship, so actual measurement is essential.
... Lumbar interbody fusion is suitable for patients with pain or vertebral instability [4] . Posterior lumbar interbody fusion (PLIF) has always been considered as a classical surgical method for the treatment of this lumbar degenerative disease [5] . In order to perform posterior lumbar interbody fusion (PLIF), most of the bones needed in traditional fusion come from autogenous iliac bone [6] . ...
... Posterior lumbar interbody fusion (PLIF) is an effective surgical method for the treatment of degenerative lumbar disc herniation [5] . In 1991, Hambly et al. [15] took the lead in using unilateral pedicle screw combined with autogenous bone graft fusion to treat patients with lumbar degeneration, and the nal follow-up of the patients with bone graft fusion rate was 85%. ...
Objective
A retrospective study of the clinical and radiological results between local bone graft with a cage and without cage in patients treated with unilateral fixation and posterior lumbar interbody fusion surgery.
Methods
A total of 52 patients who underwent PLIF in our institution were evaluated from January 2015 to January 2018. 30 of these patients received PLIF with local bone graft combined with using one cage, and 22 patients received PLIF with local bone graft without using cage. The clinical data and perioperative complications of the two groups were recorded. X-ray were taken before, after operation and at the end of follow-up to calculate the height of intervertebral disc and the fusion rate. SUK's criteria were used to evaluate the quality of spinal fusion at the follow-up time. The results between the cage and non- cage group were compared.
Results
There was no statistical difference in baseline data between the two groups, and The mean follow-up time was 18.43 months in cage group and 17.50 months in non- cage group (P = 0.553). In additions, the significant difference was not found in the comparison of perioperative evaluation data between the two groups, such as operation time (P = 0.299), blood loss (P = 0.342) and incidence of complications (P = 1.000). Furthermore, the significant difference of VAS score cannot be found in preoperation (Pleg=0.731, Plowback=0.786), postoperation (Pleg=0.534, Plowback=0.725) and the final follow-up (Pleg=0.654, Plowback=0.362) between the two groups. The same results were also obtained in the comparison of ODI index (Ppre=0.682, Pfinal=0.712) and intervertebral height (Ppost=0.363, Pfinal=0.094). The final fusion rates were 96.7% (cage group) and 86.4% (non- cage group) respectively, and there was no statistical difference (P = 0.553).
Conclusion
Local bone graft has the same advantages as a cage in unilateral PLIF. Comparing with local bone graft using cage, we believe that the local bone graft is a more ideal way in unilateral PLIF, and decrease operation cost.
... It is attributable to the technical problem that the procedure code for posterior lumbar interbody fusion and a procedure code for transforaminal lumbar interbody fusion were the same in the Korean Health Insurance Review & Assessment Service (HIRA) database. Fortunately, clinical outcomes were not different between the patients who underwent posterior lumbar interbody fusion and those who underwent transforaminal lumbar interbody fusion [19][20][21][22] , even though the perioperative complications including wound infection, hematoma, neurologic deficit, cerebrospinal fluid leakage, and screw misplacement was higher in the patients who underwent posterior lumbar interbody fusion [21][22][23] . There has been no study comparing the long-term complication of the repeat decompression and posterior fusion rates between the two groups. ...
... It is attributable to the technical problem that the procedure code for posterior lumbar interbody fusion and a procedure code for transforaminal lumbar interbody fusion were the same in the Korean Health Insurance Review & Assessment Service (HIRA) database. Fortunately, clinical outcomes were not different between the patients who underwent posterior lumbar interbody fusion and those who underwent transforaminal lumbar interbody fusion [19][20][21][22] , even though the perioperative complications including wound infection, hematoma, neurologic deficit, cerebrospinal fluid leakage, and screw misplacement was higher in the patients who underwent posterior lumbar interbody fusion [21][22][23] . There has been no study comparing the long-term complication of the repeat decompression and posterior fusion rates between the two groups. ...
There is a low incidence of reoperation after surgery. It is difficult to detect statistical differences between reoperation rates of different lumbar fusion surgeries. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. The purpose is to compare the repeat decompression and fusion rate after surgery for degenerative lumbar diseases according to different surgical fusion procedures based on national population-based databases and elucidate the risk factor for repeat decompression and fusions. The Korean Health Insurance Review & Assessment Service database was used. Patients diagnosed with degenerative lumbar diseases and who underwent single-level fusion surgeries between January 1, 2011, and June 30, 2016, were included. They were divided into two groups based on procedure codes: posterolateral fusion or posterior/transforaminal lumbar interbody fusion. The primary endpoint was repeat decompression and fusion. Age, sex, the presence of diabetes, osteoporosis, associated comorbidities, and hospital types were considered potential confounding factors. The repeat decompression and fusion rate was not different between the patients who underwent posterolateral fusion and those who underwent posterior/transforaminal lumbar interbody fusion. Old age, male sex, and hospital type were noted to be risk factors. The incidence of repeat decompression and fusion was independent on the fusion method.
Study design:
network meta-analysis.
Objective:
To compare the clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open transforaminal lumbar interbody fusion (OTLIF) in the treatment of lumbar degenerative diseases (LDDs).
Method:
A literature search was conducted in the PubMed, Embase, and Cochrane Library databases. Studies comparing Endo-LIF, MIS-TLIF and OTLIF published from September 2017 to September 2022 for the treatment of LDD were retrieved. Data were extracted from preset clinical outcome measures, including operation time, estimated intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, etc.
Result:
Thirty-one studies with 3467 patients were included in this study. Network meta-analysis showed that in the comparison of the 3 procedures, Endo-LIF was superior to MIS-TLIF and OTLIF in terms of reducing EBL, LOS, time to ambulation, and VAS score of back pain. MIS-TLIF was superior to Endo-LIF in terms of ODI improvement, and OTLIF required the shortest intraoperative fluoroscopy time. There was no significant difference in operative time, complication rate, fusion rate, VAS score of leg pain, or JOA score among the 3 procedures.
Conclusion:
Endo-LIF, MIS-TLIF and OTLIF each have their own advantages and disadvantages and show similar results in many respects, except for better early outcomes achieved with the more minimally invasive procedure.
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.
