Suzanne L de Kunder1, Sander M J van Kuijk2, Kim Rijkers3, Inge J M H Caelers4, Wouter L W van Hemert5, Rob A de Bie6, Henk van Santbrink7. 1. Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands. Electronic address: suzannedekunder@gmail.com. 2. Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands. 3. Department of Neurosurgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands. 4. Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands. 5. Department of Orthopedic Surgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands. 6. CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands. 7. Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands; Department of Neurosurgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands.
Abstract
BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are both frequently used as a surgical treatment for lumbar spondylolisthesis. Because of the unilateral transforaminal route to the intervertebral space used in TLIF, as opposed to the bilateral route used in PLIF, TLIF could be associated with fewer complications, shorter duration of surgery, and less blood loss, whereas the effectiveness of both techniques on back or leg pain is equal. PURPOSE: The objective of this study was to compare the effectiveness of both TLIF and PLIF in reducing disability, and to compare the intra- and postoperative complications of both techniques in patients with lumbar spondylolisthesis. STUDY DESIGN/ SETTING: A systematic literature review and meta-analysis were carried out. METHODS: We conducted a Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov and NHS Centre for Review and Dissemination search for studies reporting TLIF, PLIF, lumbar spondylolisthesis and disability, pain, complications, duration of surgery, and estimated blood loss. A meta-analysis was performed to compute pooled estimates of the differences between TLIF and PLIF. Forest plots were constructed for each analysis group. RESULTS: A total of 192 studies were identified; nine studies were included (one randomized controlled trial and eight case series), including 990 patients (450 TLIF and 540 PLIF). The pooled mean difference in postoperative Oswestry Disability Index (ODI) scores between TLIF and PLIF was -3.46 (95% confidence interval [CI] -4.72 to -2.20, p≤.001). The pooled mean difference in the postoperative VAS scores was -0.05 (95% CI -0.18 to 0.09, p=.480). The overall complication rate was 8.7% (range 0%-25%) for TLIF and 17.0% (range 4.7-28.8%) for PLIF; the pooled odds ratio was 0.47 (95% CI 0.28-0.81, p=.006). The average duration of surgery was 169 minutes for TLIF and 190 minutes for PLIF (mean difference -20.1, 95% CI -33.5 to -6.6, p=.003). The estimated blood loss was 350 mL for TLIF and 418 mL for PLIF (mean difference -43.9 mL, 95% CI -71.2 to -16.6, p=.002). CONCLUSIONS: TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF.
BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are both frequently used as a surgical treatment for lumbar spondylolisthesis. Because of the unilateral transforaminal route to the intervertebral space used in TLIF, as opposed to the bilateral route used in PLIF, TLIF could be associated with fewer complications, shorter duration of surgery, and less blood loss, whereas the effectiveness of both techniques on back or leg pain is equal. PURPOSE: The objective of this study was to compare the effectiveness of both TLIF and PLIF in reducing disability, and to compare the intra- and postoperative complications of both techniques in patients with lumbar spondylolisthesis. STUDY DESIGN/ SETTING: A systematic literature review and meta-analysis were carried out. METHODS: We conducted a Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov and NHS Centre for Review and Dissemination search for studies reporting TLIF, PLIF, lumbar spondylolisthesis and disability, pain, complications, duration of surgery, and estimated blood loss. A meta-analysis was performed to compute pooled estimates of the differences between TLIF and PLIF. Forest plots were constructed for each analysis group. RESULTS: A total of 192 studies were identified; nine studies were included (one randomized controlled trial and eight case series), including 990 patients (450 TLIF and 540 PLIF). The pooled mean difference in postoperative Oswestry Disability Index (ODI) scores between TLIF and PLIF was -3.46 (95% confidence interval [CI] -4.72 to -2.20, p≤.001). The pooled mean difference in the postoperative VAS scores was -0.05 (95% CI -0.18 to 0.09, p=.480). The overall complication rate was 8.7% (range 0%-25%) for TLIF and 17.0% (range 4.7-28.8%) for PLIF; the pooled odds ratio was 0.47 (95% CI 0.28-0.81, p=.006). The average duration of surgery was 169 minutes for TLIF and 190 minutes for PLIF (mean difference -20.1, 95% CI -33.5 to -6.6, p=.003). The estimated blood loss was 350 mL for TLIF and 418 mL for PLIF (mean difference -43.9 mL, 95% CI -71.2 to -16.6, p=.002). CONCLUSIONS: TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF.
Authors: Zhijie Yang; Bo Liu; Haiyang Lan; He Ye; Jie Chen; Huiqiang Xia; Ye Zhang; Fei Han Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Date: 2020-05-15