Introduction: The indications and applications of either PLIF or TLIF procedures have grown. Both types of fusion techniques have shown similar biomechanical properties, however, at present there is still no convincing evidence showing clinical advantage of one technique over another. Instrumentation costs may be the only significant difference.
Methods: 611 consecutive patients who underwent lumbar fusion using either PLIF (N=500) or TLIF (N=111) were analyzed. Surgical outcomes were evaluated based on complications, symptomatic improvement, re-operation incidence, hospitalized days, cost of procedure, and postoperative clinical outcomes using Prolo/Oswestry disability index (ODI) outcome scores.
Results: Preoperative diagnosis was similar between both studied groups with degenerative disc disease, spondylolisthesis and adjacent level disease as the main pathologies.
TLIF patients had 3.6% rate of complication. Mean hospital stay was 4.6 days with a re-operation rate of 17%. The average economical, functional and total Prolo scores for this group were 4.00, 4.02, and 8.01, respectively. Mean postoperative ODI was 20%, and 90.9% of patients showed symptomatic improvement at 3 months follow-up.
PLIF patients had 5% rate of complications. Mean hospital stay was 5.1 days with a re-operation rate of 14%. The average economical, functional, and total Prolo scores for PLIF were 4.07, 4.04, and 8.1, respectively. Mean postoperative ODI was 18.9%, and 84% of patients showed symptomatic improvement at 3 months follow-up.
When comparing all clinical variables between both types of procedures, no statistical differences were seen. The costs of a single level PLIF compared to TLIF were significantly higher with a 32% increase in the instrumentation cost with the use of PLIF.
Conclusions: Similar operative outcomes, duration of hospital stay and re-operation rates were seen with both techniques. Both procedures showed to have low complication rates with positive short term clinical outcomes. However, PLIF surgeries require two interbody devices, thereby increasing the cost of instrumentation.
Patient Care: We present a comparative analysis of 611 consecutive patients who underwent lumbar interbody fusion using either PLIF or TLIF procedures in order to evaluate the clinical advantages of one technique over the other. Surgical outcomes were evaluated based on complications, symptomatic improvement, re-operation incidence, hospitalized days, and postoperative clinical outcomes. No statistical difference was seen in the clinical outcomes between TLIF and PLIF patients. However, PLIF surgeries require two interbody devices, thereby increasing the cost of instrumentation.
Learning Objectives: 1) Describe the uses and indications of posterior interbody spinal fusion 2) Identify the outcomes and differences between PLIF and TLIF 3) Identify an optimal treatment strategy for posterior fusions