Posterolateral Versus Transforaminal Interbody L4/5 Fusion: Correlation With Subsequent Surgery.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spine Surgery

Background:

• Lumbar stenosis and degenerative spondylolisthesis often require surgical decompression and fusion.
• Reoperation is a significant concern following lumbar fusion procedures.
• Optimal fusion techniques to minimize subsequent surgeries remain under investigation.

Purpose of the Study:

• To compare posterolateral interbody fusion (PLF) versus PLF with transforaminal interbody fusion (PLF+TLIF) for L4/5 segment fusion.
• To evaluate differences in subsequent surgery rates, clinical outcomes, radiographic parameters, and patient satisfaction between PLF and PLF+TLIF.

Main Methods:

• Retrospective cohort study of 89 patients with L4/5 stenosis and degenerative spondylolisthesis undergoing isolated decompression and fusion.
• Patients were treated with either PLF (31) or PLF+TLIF (58) between 2006 and 2012.
• Outcomes assessed included subsequent surgery rates, patient-reported outcomes (ODI, VAS), radiographic parameters (lordosis), and patient satisfaction over a minimum 5-year follow-up.

Main Results:

• At an average 8.7-year follow-up, 6% of PLF patients (2/31) required subsequent surgery versus 28% of PLF+TLIF patients (16/58) (P=0.02).
• No significant differences were observed between the groups regarding sex, age, BMI, tobacco use, perioperative measures, patient-reported outcomes, or radiographic parameters (P>0.05).

Conclusions:

• Both PLF and PLF+TLIF are effective for L4/5 stenosis and spondylolisthesis.
• PLF was associated with a significantly lower rate of subsequent lumbar surgery compared to PLF+TLIF.
• Further research is needed to identify factors guiding the choice between PLF and PLF+TLIF.