Evaluating posterior column osteotomy in single-level transforaminal lumbar interbody fusion: A retrospective study

Retrospective cohort study.ObjectivesTo evaluate the impact of combining posterior column osteotomy (PCO) with single-level transforaminal lumbar interbody fusion (TLIF) on postoperative complications and long-term outcomes.

Patients undergoing single-level TLIF (CPT-22633) from 2010 to 2019 were identified. Exclusion criteria included malignancy, trauma, infection, or age <18. After matching for demographics and comorbidities, 3221 patients undergoing TLIF with PCO (CPT-22214) were compared to 16,021 patients undergoing TLIF alone, with at least two years of follow up. Multivariable logistic regression was used to assess 90-day medical and surgical complications, two-year pseudarthrosis and hardware failure, and five-year reoperation rates.

Patients undergoing TLIF with PCO had significantly higher rates of 90-day medical complications, including atelectasis (1.9% vs. 1.3%, OR 1.51, p = 0.004), respiratory failure (1.6% vs. 0.7%, OR 2.32, p < 0.001), and pulmonary embolism (0.6% vs. 0.3%, OR 1.83, p = 0.028). Surgical complications were also more frequent, including transfusion (0.8% vs. 0.4%, OR 2.12, p = 0.001) and postoperative radiculopathy (3.4% vs. 2.5%, OR 1.38, p = 0.002). The TLIF-PCO group had a higher rate of pseudarthrosis at two years (3.8% vs. 3.1%, OR 1.25, p = 0.029) and reoperations within five years (13.3% vs. 11.4%, p < 0.001).

The addition of PCO to TLIF is associated with increased medical and surgical complications, as well as a higher rate of pseudarthrosis and reoperation. Future research should focus on radiographic and patient-reported outcomes to refine surgical strategies and optimize long-term results.