Transforaminal lumbar interbody fusion (TLIF) with or without anterior release (TFAR) using expandable interbody...

Transforaminal lumbar interbody fusion (TLIF) can be extended by transforaminal anterior release (TFAR), to open and distract degenerated segments and increase segmental lordosis (SL).

To analyze the rate, type and severity of adverse events (AEs), as well as spinopelvic parameters and clinical outcomes.

We reviewed consecutive patients treated with TLIF with expandable interbody spacers. TFAR patients were matched 1:5 to a control group (conventional TLIF).

We identified n = 435 patients (541 TLIF levels; mean age 65.2 years; 55.7% female), of which n = 30 patients (39 levels) were assigned to the TFAR group and n = 149 (247 TLIF levels) to the control group. TFAR procedures took longer (mean difference (MD) 86min, p = 0.004) and had a higher blood loss (MD 463 ml, p = 0.022). In multivariable analysis, TFAR patients were more likely to experience intraoperative AEs (OR 3.49, 95% CI 1.47 - 8.31, p = 0.005) and early postoperative AEs (OR 2.39, 95% CI 0.99 - 5.76, p = 0.051), while the risk for further AEs at 90 days and 12 months was similar. Patients in the TFAR group were more likely to achieve a favorable 12-month outcome (OR 2.71, 95% CI 1.13 - 6.51, p = 0.025). TFAR patients had consistently more SL during follow-up (12 month: 24.9° vs. 18.9°, p < 0.001) and the pelvic incidence (PI)-LL mismatch was lower (0.4° vs. 7.2°, p = 0.020).

We found a 3-fold increase in intraoperative and early postoperative AEs in TFAR patients, while the mid- and longer-term outcomes were similar or even slightly better than in patients undergoing conventional TLIF.