Related Experiment Video
Updated: Jan 11, 2026
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
Radiographic and Clinical Comparison of Lateral Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion
Frank A De Stefano1, Anand A Dharia, Andrew R Guillotte
1Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA fdestefano@kumc.edu.
Background:
Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are 2 surgical approaches for achieving arthrodesis and restoring alignment. Novel expandable interbody technology may provide an advantage for TLIF procedures. Limited comparative data exist for LLIF with static interbody cages and TLIF with expandable interbody cages. This study aimed to examine the differences in radiographic and clinical outcomes between these procedures.
Methods:
This is a retrospective analysis comparing single-level LLIF with static interbody cages and TLIFs with expandable interbody cages performed at our institution. Demographic, operative, radiographic, and patient-reported data were collected. Upright radiographic images were used to assess pre- and postoperative radiographic parameters. Patient-reported outcomes were assessed using the Oswestry Disability Index and minimal clinically important difference (MCID).
Results:
A total of 163 patients, 75 in the TLIF group and 88 in the LLIF group, were included in this study (mean age: 63.3 ± 12.0 years; 54.8% women). Mean follow-up was 306.2 ± 161.4 days for the TLIF group and 502.3 ± 308.0 days for the LLIF group (P = 0.021). Both groups demonstrated significant improvements in lumbar lordosis, neuroforaminal height, and disc angle (P < 0.01). LLIF patients demonstrated a significant correction of segmental lordosis (P < 0.01), whereas TLIF patients did not (P > 0.05). Patients in the LLIF group demonstrated a greater increase in segmental lordosis (P = 0.005) and neuroforaminal height (P < 0.001) in comparison to those in the TLIF group. In addition, a modest but significant advantage was observed in overall lumbar lordosis in LLIF (P = 0.049). A significantly greater proportion of patients who underwent LLIF achieved an MCID (80.6% vs 66.7%, P = 0.041). The LLIF group had significantly fewer cases of radiographic subsidence than TLIF (10.2% vs 44%, P < 0.001). TLIF was the only significant predictor of subsidence (OR = 4.630 [1.493-14.364], P < 0.001).
Conclusions:
LLIF resulted in greater restoration of neuroforaminal height and segmental lordosis, as well as a modest advantage in lumbar lordosis. In addition, a significantly greater proportion of patients who underwent LLIF achieved MCID. TLIF was a significant predictor of subsidence when controlling for confounding factors.
Clinical Relevance:
With the advent of expandable interbodies in TLIF, our findings demonstrate suboptimal radiographic and patient-reported outcomes in comparison to LLIF with static interbody cages. Surgeons should exercise caution regarding utilizing expandable interbody technology during TLIF.
