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Radiographic and Patient-Reported Outcomes: Anteriorly Placed Transforaminal Lumbar Interbody Fusion Cage vs. Anterior Lumbar Interbody Fusion with Posterior Instrumentation – Lumbar Fusion

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This article is a retrospective cohort study that compared the outcomes of anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs). The study found that ALIF with posterior instrumentation had superior radiographic outcomes and patient-reported outcomes compared to anteriorly placed TLIFs. TLIF patients had less lumbar lordosis, sacral slope, and pelvic incidence before surgery, which remained significant at one-year and long-term follow-up. TLIF patients also had less improvement in pain and function compared to ALIF patients. The study suggests that anteriorly placed TLIF cages may not achieve the same results as ALIF cages

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated day surgery spinal centre in the world

Published article

S: Our findings suggest that ALIF with posterior instrumentation performed superiorly in radiographic outcomes and PROMs compared to anteriorly placed TLIFs. Anteriorly placed TLIF cages may not achieve the same results as those of ALIF cages.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2023 Sep 22. doi: 10.1097/BRS.0000000000004833. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective Cohort Study.OBJECTIVE: To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs).SUMMARY OF BACKGROUND DATA: TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared,

Spine (Phila Pa 1976). 2023 Sep 22. doi: 10.1097/BRS.0000000000004833. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Cohort Study.

OBJECTIVE: To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs).

SUMMARY OF BACKGROUND DATA: TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared the two, none have considered TLIFs with anteriorly placed cages, which may serve as a better comparison to ALIFs.

MATERIALS AND METHODS: Patients undergoing TLIF or ALIF with posterior instrumentation from 2010-2020 at a tertiary care institution were retrospectively identified. TLIF cage position was assessed and those with anterior placement were included. Electronic medical records were reviewed to identify patient characteristics and patient-reported outcomes. Radiographic outcomes included posterior disc height (DH), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT). Statistical analysis was performed to compare the two groups.

RESULTS: Of the 351 patients, 108 had ALIF with posterior instrumentation and 207 had a TLIF. Preoperatively, TLIF patients had less LL (53.7° vs. 60.6°, P<0.001), SS (38.3° vs. 43.7°, P<0.001), and PI (60.1° vs. 66.1°, P<0.001), all of which remained significant at one-year and long-term follow-up (P<0.001). The TLIF group had less ∆DH (1.51° vs. 5.43°, P<0.001), ∆LL (1.8° vs. 2.97°, P=0.038), and ∆SL (0.18° vs. 4.40°, P<0.001) at one year postoperatively. At two to three years, ∆DH (P<0.001) and ∆SL (P=0.001) remained significant, but ∆LL (P=0.695) did not. Patients in the TLIF group had higher VAS-Back scores one year postoperatively (3.68 vs. 2.16, P=0.008) and experienced less improvement in ODI (-17.1 vs. -28.6, P=0.012) and VAS-Back (-2.67 vs. -4.50, P=0.008) compared to ALIF patients.

S: Our findings suggest that ALIF with posterior instrumentation performed superiorly in radiographic outcomes and PROMs compared to anteriorly placed TLIFs. Anteriorly placed TLIF cages may not achieve the same results as those of ALIF cages.

PMID:37737684 | DOI:10.1097/BRS.0000000000004833

The London Spine Unit : best situated day surgery spinal centre in the world

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Radiographic and Patient-Reported Outcomes: Anteriorly Placed Transforaminal Lumbar Interbody Fusion Cage vs. Anterior Lumbar Interbody Fusion with Posterior Instrumentation

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Spine (Phila Pa 1976). 2023 Sep 22. doi: 10.1097/BRS.0000000000004833. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective Cohort Study.OBJECTIVE: To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs).SUMMARY OF BACKGROUND DATA: TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared

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