Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other

Various surgical procedures have been recommended for the treatment of degenerativespondylolisthesis,but Controversy still exists regarding the optimal surgical technique . In this study,wecompared the clinical and radiologic outcome of the Transforaminal lumbar interbody fusion(TLIF)method with the Instrumented Posterolateral fusion(PLF) in these patients.Methods: The study population in this retrospective study consisted of 145 consecutive patients of degen-erative spondylolisthesis who had undergone lumbar fusion in our institute between September 2010 andOctober 2013. The patients were divided into two treatment groups, where either instrumented PLF withpedicle screw(180◦fusion) or TLIF procedure(360◦fusion) was done. The follow-up was performed clini-cally using the Oswestry Disability Index (ODI), visual analogue scale (VAS)and global outcome. Outcomescores were assessed at 3, 6, 12, and 24 months after surgery. Radiographs were obtained postoperativelyand at regular intervals for 24 months. Perioperative outcomes such as surgery time, blood loss, lengthof hospital stay and incidence of surgical complications were also recorded.Results: 80 patients underwent TLIF procedure and 65 patients were included in the instrumented PLFgroup. There were no significant differences between the groups with respect to age,gender,Body MassIndex,smoking and comorbid conditions(p > 0.05). No significant difference existed in Pre-operative VASfor back pain,VAS for leg pain and ODI between the two groups(p > 0.05). There were no significant groupdifferences in the operation level,hospital stay and surgical complications(all p > 0.05). Blood loss, oper-ation time and fusion success rate were significantly greater in the TLIF group than in the PLF group (allP < 0.05). Significant differences between groups concerning VAS for back pain,ODI and Global outcomewere present at final follow-up. There was no significant difference between the two groups with respectto VAS for leg pain.Conclusion: Our study showed that TLIF is superior to PLF with respect to functional outcome and fusionrate.