Which is better?Transforaminal Lumbar Interbody Fusion Vs. Posterolateral Fusion in Treating Degenerative Spondylolisthesis

Background and Objective: Degenerative spondylolisthesis can be treated surgically with various techniques like trans-foraminal lumbar interbody fusion [TLIF] and postero-lateral fusion [PLF] which are the most common techniques used in practice. In our study we describe our experience in these techniques in treating degenerative spondylolisthesis regarding outcome and complications.

Method: This prospective study was conducted upon 32 patients with degenerative spondylolisthesis, divided in 2 groups randomly selected; one group will be operated upon by posterolateral fixation and the other group by TLIF at the Department of Neurosurgery, Cairo University Kasr Alainy. We evaluated surgical outcomes in terms of clinical improvement and complications.

Results: Thirty-two patients were included in this series; divided in two groups. Postoperative mean visual assessment score (VAS) in TLIF group was 1.5 regarding leg pain and 2.75 regarding back pain, while in the PLF group was 1.56 regarding leg pain while 2.87 regarding back pain.

In TLIF group one patient suffered from canal encroachment by L5 screw causing severe sciatica and it needed reoperation and screw revision.

In PLF group two patients suffered from weakness, one of them was in the form of increase in weakness of the hip flexion and the other was new weakness in dorsiflexion and they were treated conservatively and physiotherapy, and they showed mild improvement. One patient suffered from superficial wound infection and mild dehiscence and was treated by antibiotics and bedside secondary sutures under local anesthesia.

Conclusion: No statistical significance difference in term of clinical improvement in both groups regarding back and leg pain.