Comparison of Posterior Instrumentation With and Without Interbody Fusion for Degenerative Spinal Stenosis

This is a retrospective comparative cohort study.

The aim of this study was to compare the radiologic and functional outcomes of patients undergoing short-segment instrumentation for lumbar spinal stenosis, specifically those treated with posterior instrumentation and decompression alone versus those treated with posterior instrumentation, decompression, and transforaminal lumbar interbody fusion (TLIF).

TLIF is often added to improve stability and fusion in lumbar spinal stenosis surgery. However, the additional clinical benefit of TLIF in short-segment degenerative lumbar stenosis remains controversial due to its association with increased operating time and perioperative morbidity.

Twenty-four underwent TLIF in combination with posterior spinal instrumentation (PSI), whereas 26 received only PSI and decompression. Surgical duration, postoperative complications, symptom duration, intrahospital blood transfusion requirements, complications, radiologic images and fusion levels were retrospectively analyzed. The ODI and VAS scores were evaluated preoperatively and at the final follow-up.

There were no statistically significant differences between the groups in terms of age, symptom duration, follow-up, preoperative or postoperative VAS and ODI scores, ASA scores, complication, number of fusions, or length of hospital stay. However, the operative duration was significantly longer and blood transfusion rates were significantly higher in the TLIF group than in the control group (P<0.05).

PSI with TLIF provides superior radiologic fusion outcomes in short-segment spinal stenosis surgery but does not offer a clear clinical advantage over PSI with decompression. Furthermore, it may result in longer operative duration, greater intraoperative blood loss, and may contribute to higher hospital costs.