Clinical and Patient-reported Outcomes after Posterior Versus Transforaminal Lumbar Interbody Fusion - A Propensity Score-matched Cohort Study on 422 Patients with 2-year Follow-up

Søren Ohrt-Nissen, Leah Y Carreon, Andreas K Andresen, Mikkel O Andersen, Peter Udby

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Study Design.This was a dual-center study over an eight-year period on patients undergoing single level fusion surgery with either posterior- (PLIF) or transforaminal lumbar interbody fusion (TLIF). We analyzed prospectively collected pre- and postoperative data from the national Danish surgical spine database (DaneSpine).Objective.The aim of this study was to compare clinical and patient-reported outcome (PRO) 2 years after TLIF or PLIF in patients with symptomatic lumbar mechanical disc degeneration.Summary of Background Data.PLIF and TLIF are well-described techniques for treating lumbar mechanical disc degeneration but whether the theoretical differences between the two techniques translate to different clinical outcomes is unknown.Methods.The primary outcome was Oswestry Disability Index (ODI) score at 2-year follow-up. Secondary outcome measures were scores on the European Quality of Life-5 Dimensions (EQ-5D) and visual analog scale (VAS) and the rate of intraoperative complications. To minimize baseline differences between the groups, propensity-score matching was employed in a 1:1 fashion, balancing the groups on preoperative factors including age, sex, back and leg pain, ODI, EQ-5D, and previous spine surgery.Result.The matched cohort included 211 patients in each cohort. There was no significant difference between the groups in the mean score on the ODI at two years (PLIF: 33 ± 20 vs. TLIF: 35 ± 20, P = 0.328). We found no statistically significant differences in EQ-5D score (0.54 ± 0.35 vs. 0.51 ± 0.34, P = 0.327), VAS score for back pain (47 ± 32 vs. 48 ± 29, P = 0.570) or leg pain (42 ± 33 vs. 41 ± 32, P = 0.936) between the PLIF and TLIF groups, respectively, at 2-year follow-up. Dural tears occurred in 9.5% in the PLIF group and 1.9% in the TLIF group (P = 0.002) corresponding to a relative risk of 5.0 (95% CI 1.7-14.4).Conclusion.We found no significant difference in PRO at 2-year follow-up between PLIF and TLIF for the treatment of lumbar disc degeneration. PLIF is associated with a five times higher risk of dural tears.Level of Evidence: 3.

Original languageEnglish
JournalSpine
Volume47
Issue number2
Pages (from-to)180-185
ISSN0362-2436
DOIs
Publication statusPublished - 15. Jan 2022

Bibliographical note

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • PLIF
  • TLIF
  • degenerative disc disease
  • disability
  • disc degeneration
  • lumbar fusion
  • oswestry disability index
  • patient-reported outcome
  • propensity-score matching
  • Spondylolisthesis
  • Lumbar Vertebrae/surgery
  • Follow-Up Studies
  • Humans
  • Propensity Score
  • Quality of Life
  • Spinal Fusion/adverse effects
  • Cohort Studies
  • Patient Reported Outcome Measures

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