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BACKGROUND: Anterior lumbar interbody fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF) may be used to correct the lumbosacral fractional curve (LsFC) in de novo adult (thoraco) lumbar scoliosis. Yet, the relative benefits of ALIF and TLIF for LsFC correction remain largely undetermined. PURPOSE: To compare the currently available data comparing radiographic correction of the LsFC provided by ALIF and TLIF of LsFC in adult (thoraco)lumbar scoliosis. METHODS: A systematic review was performed on original articles discussing fractional curve correction of lumbosacral spinal deformity (using search criteria: lumbar and fractional curve). Articles which discussed TLIF or ALIF for LsFC correction were presented and radiographic results for TLIF and ALIF were compared. RESULTS: Thirty-one articles were returned in the original search criteria, with 7 articles included in the systematic review criteria. All 7 articles presented radiographic results using TLIF for LsFC correction. Three of these articles also discussed results for patients whose LsFC were treated with ALIFs; 2 articles directly compared TLIF and ALIF for LsFC correction. Level III and level IV evidence indicated ALIF as advantageous for reducing the coronal Cobb angle of the LsFC. There were mixed results on relative efficacy of ALIF and TLIF in the LsFC for restoration of adequate global coronal alignment. CONCLUSIONS: Limited level III and IV evidence suggests ALIF as advantageous for reducing the coronal Cobb angle of the LsFC in de novo adult (thoraco) lumbar scoliosis. Relative efficacy of ALIF and TLIF in the LsFC for restoration of global coronal alignment may be dictated by several factors, including directionality and magnitude of preoperative coronal deformity. Given the limited and low-quality evidence, additional research is warranted to determine the ideal interbody support strategies to address the LsFC in adult (thoraco) lumbar scoliosis.

To investigate the improvement of spinopelvic parameters and therapeutic efficacy in the treatment of complex degenerative lumbar spondylolisthesis (CDLS) after oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF). From January 2018 to December 2020, 71 patients with CDLS underwent OLIF or TLIF at the same hospital: 31 in the OLIF group and 40 in the TLIF group. The spinopelvic parameters, perioperative data, and clinical outcomes were elected and compared between the 2 groups. There were no statistic differences in demographic perioperative complication rates and preoperative spinopelvic parameters between the two groups. OLIF group showed lower serum C-reactive protein in the early postoperative stage, shorter length of stay, less estimated blood loss and larger slippage correction rate (88.05 vs. 62.37%) (all P ＜ 0.05). There was no significant difference in the visual analog scale and Oswestry disability index scores before operation and three and six months after surgery, but OLIF group was better in the long-term with visual analog scale and Oswestry disability index (1.7/13.2 vs. 2.3/16.5). And it was significantly different in the lumbar lordosis angle, segmental lordosis angle, pelvic tilt, sacral slope (46.0°/9.3°/18.2°/35.9° vs. 40.4°/7.2°/23.9°/31.1°), and sagittal vertical axis (21.6 vs. 31.7mm) after surgery between OLIF and TLIF groups (all P ＜ 0.05). In the therapy of CDLS, OLIF can better reduce pelvic tilt, L1 axis S1 distance, and sagittal vertical axis, and increase lumbar lordosis angle and sacral slope, showing advantages over TLIF in improving and maintaining spinopelvic parameters. Although there was no difference in complication rates between OLIF and TLIF, OLIF was more minimally invasive, had less tissue damage, had faster recovery, and had better long-term outcomes. [ABSTRACT FROM AUTHOR]

To determine the impact of epidural spinal injections (ESIs) on postoperative surgical complications. This retrospective all-payer database analysis identified 202,181 adult patients undergoing one- to three-level transforaminal lumbar interbody fusion (TLIF) from 2010 to 2020. A 1:1 exact matching on comorbidities and demographics was performed, creating 2 cohorts: 1) patients who received an ESI within 90 days of surgery and 2) patients who did not receive an ESI. The primary outcome was surgical complication rates between groups at 30 days postoperatively. For the secondary outcome, patients were stratified based on injection time before surgery: 1–30, 31–45, 46–60, 61–75, and 76–90 days. Logistic regression was performed between groups to identify temporal associations of complication rates. The P value was set to 0.05 for the primary analysis, and the Bonferroni correction was utilized for the secondary outcome. Exact matching produced 12,491 pairs for analysis. Groups were well-matched on demographics, comorbidities, and fusion levels. The 30-day postoperative rates of surgical complications, hematomas, wound disruptions, or surgical site infections did not differ between groups (P > 0.05). The rate of cerebrospinal fluid (CSF) leak was increased in the ESI group (0.19% vs. 0.09%, P = 0.042). When temporally stratified, patients receiving an ESI within 30 days had significantly higher odds of CSF leak (odds ratio: 4.24, 95% confidence interval: 1.97–9.14). Patients who receive an ESI within 30 days of transforaminal lumbar interbody fusion are at an increased risk for CSF leak. While the incidence of CSF leak remains small, it may be advisable to avoid ESIs at least 30 days before surgery for certain patients. [ABSTRACT FROM AUTHOR]

Introduction: Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications. Materials and methods: Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union. Results: Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn’t respond, and one patient died due to uncontrolled infection. Conclusion: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.

Objective Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium‐ to long‐term follow‐up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. Methods This was a retrospective study that included 273 patients with single‐level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1‐day, 1‐week, 1‐year, and 5‐year follow‐ups. Complications, recurrences, and 5‐year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t‐tests, repeated measures analysis of variance (ANOVA), and χ2 tests. Results Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow‐ups (p

Study Design. Retrospective review of prospectively collected data. Objectives. This study aimed to compare the clinical outcomes of obese patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Summary of Background Data. The perioperative benefits of minimally invasive surgery in obese patients have been described. However, there is limited literature on the patient-reported outcomes (PROs), satisfaction and return to work following MIS-TLIF and open TLIF in this subgroup of patients. Materials and Methods. Obese patients (BMI ≥ 30.0 kg/m²) who underwent a primary, one-level to two-level open and MIS-TLIF were stratified and matched using propensity scoring. Operative time, length of stay, and perioperative outcomes were recorded. Patient-reported outcomes (PROs) including Oswestry disability index, Short Form-36 physical component score, mental component score, visual analogue scale for back pain and leg pain were compared at each postoperative time point. Achievement of minimal clinically important difference (MCID), patient satisfaction and return to work were also assessed. Revision procedures were recorded at mean 10 ± 3.3 years follow-up. Results. In total, 236 obese patients were included: 118 open TLIF and 118 MIS-TLIF. Length of stay was longer in the open TLIF cohort and there was a trend toward a higher complication rate. However, there was no difference in operative time, transfusions, or readmissions. Patients who underwent open TLIF reported worse ODI (P = 0.043) and VAS leg pain at two years, although the latter did not reach statistical significance (P = 0.095). Achievement of MCID for each PRO, patient satisfaction, and return to work were also comparable. Conclusions. Obese patients who underwent MIS-TLIF had a shorter length of stay and improved functional disability at two years compared those who underwent open TLIF. However, a similar proportion achieved a clinical meaningful improvement. Patient satisfaction and return to work were also comparable at two years. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

The aim of the current study was to compare the incidence of postoperative complications among minimally invasive surgery (MIS) tubular, endoscopic, and robot-assisted transforaminal lumbar interbody fusion (TLIF) techniques. We studied consecutive patients who underwent single-level or multilevel TLIF between 2020 and 2022. Preoperative and postoperative patient-reported outcomes (Visual Analog Scale leg score and Oswestry Disability Index), demographic, and intraoperative variables were recorded. One-way analysis of variance with Bartlett's equal-variance and Pearson chi-squared tests were used. The study included 170 TLIF patients: 107 (63%) tubular, 42 (25%) endoscopic, and 21 (12%) robot assisted. All 3 TLIF techniques had similar complication rates: tubular 6 (5.6%), endoscopic 2 (4.8%), and robot assisted 1 (4.8%) all occurring within the first 2 weeks. Tubular TLIF reported the lowest incidence of new-onset neurologic symptoms, primarily radiculitis or numbness/tingling, at 2 weeks postoperatively (P < 0.05) with 21 (20%) tubular, 17 (41%) endoscopic, and 9 (43%) robot-assisted patients. There were 2 revisions in the robot-assisted group, while tubular and endoscopic each had one within 1 year. There was no statistical difference in preoperative or postoperative patient-reported outcomes between the TLIF groups. The current study demonstrated that tubular, endoscopic, and robot-assisted TLIF procedures had similar complication rates. The tubular MIS TLIF reported fewer new neurologic symptoms compared with endoscopic and robot-assisted TLIF procedures at 2 weeks postoperative, with all groups declining in symptom persistency at later time intervals. Average Visual Analog Scale scores continuously improved up to 1 year postoperatively among all groups. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. This study compares reoperation rates and complications following single-level anterior lumbar interbody fusion (ALIF)/lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF)/posterior lumbar interbody fusion (PLIF). Summary of Background Data. ALIF, LLIF, TLIF, and PLIF are widely used for degenerative disc disease. Lumbar interbody fusions have high rates of reoperation, primarily related to adjacent segment pathology and pseudarthrosis. Materials and Methods. The PearlDiver database was queried for patients (2010-2021) who had single-level ALIF/LLIF or TLIF/PLIF with same-day, single-level posterior instrumentation. ALIF/LLIF were combined, and similarly, TLIF/PLIF were combined, given how these operations are indistinguishable from Current Procedural Terminology coding. All patients were followed for ≥ 2 years and excluded if they had spinal traumas, fractures, infections, or neoplasms before surgery. The two cohorts, ALIF/LLIF and TLIF/PLIF, were matched 1:1 based on age, sex, Elixhausercomorbidity index, smoking status, and diabetes. The primary outcome was the incidence of all-cause subsequent lumbar operations. Secondary outcomes included 90-day surgical complications. Results. After 1:1 matching, each cohort contained 14,070 patients. All-cause subsequent lumbar operations were nearly identical at five-year follow-up (9.4% ALIF/LLIF vs. 9.5% TLIF/PLIF, P=0.91). Survival analysis using all-cause subsequent lumbar operations as the endpoint showed an equivalent 10-year survival rate of 86.0% (95%CI: 85.2-86.8). Within 90 days, TLIF/PLIF had more infections (1.3% vs. 1.7%, P=0.007) and dural injuries (0.2% vs. 0.4%, P=0.001). There was no difference in wound dehiscence, hardware complications, or medical complications. Conclusion. As utilized in real-world clinical practice, singlelevel anterolateral versus posterior approaches for interbody fusion have no effect on long-term reoperation rates. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium‐ to long‐term follow‐up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. Methods: This was a retrospective study that included 273 patients with single‐level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1‐day, 1‐week, 1‐year, and 5‐year follow‐ups. Complications, recurrences, and 5‐year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t‐tests, repeated measures analysis of variance (ANOVA), and χ2 tests. Results: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow‐ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895). Conclusion: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the effect of endplate weakness prior to PLIF or TLIF cage implantation and compare it to the opposite intact endplate of the same vertebral body. In addition, the influence of bone quality on endplate resistance was investigated. Methods: Twenty-two human lumbar vertebrae were tested in a ramp-to-failure test. One endplate of each vertebral body was tested intact and the other after weakening with a rasp (over an area of 200 mm2). Either a TLIF or PLIF cage was then placed and the compression load was applied across the cage until failure of the endplate. Failure was defined as the first local maximum of the force measurement. Bone quality was assessed by determining the Hounsfield units (HU) on CT images. Results: With an intact endplate and a TLIF cage, the median force to failure was 1276.3N (693.1–1980.6N). Endplate weakening reduced axial endplate resistance to failure by 15% (0–23%). With an intact endplate and a PLIF cage, the median force to failure was 1057.2N (701.2–1735.5N). Endplate weakening reduced axial endplate resistance to failure by 36.6% (7–47.9%). Bone quality correlated linearly with the force at which endplate failure occurred. Intact and weakened endplates showed a strong positive correlation: intact-TLIF: r = 0.964, slope of the regression line (slope) = 11.8, p < 0.001; intact-PLIF: r = 0.909, slope = 11.2, p = 5.5E−05; weakened-TLIF: r = 0.973, slope = 12.5, p < 0.001; weakened-PLIF: r = 0.836, slope = 6, p = 0.003. Conclusion: Weakening of the endplate during cage bed preparation significantly reduces the resistance of the endplate to subsidence to failure: endplate load capacity is reduced by 15% with TLIF and 37% with PLIF. Bone quality correlates with the force at which endplate failure occurs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. METHODS: Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test. RESULTS: The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p  0.999). CONCLUSIONS: With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.

Objective: To correlate the operative characteristics and complications of transforaminal lumbar interbody fusion (TLIF) to patient frailty status for the first time in a multicenter study. Methods: Using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database, all patients who underwent TLIF in 2015–2020 were filtered for their demographics, operative characteristics, and 30-day complication outcomes. Patients were stratified into 2 cohorts, low and high frailty, based on their modified frailty index 5 score. Univariate analysis was performed between the 2 cohorts for each collected variable, and multivariable analysis was performed to observe adjusted odds ratios (OR). Results: The frail cohort experienced more unplanned readmission (4.3 vs 6.6 %, p

Study Design. The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022. Objective. To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1. Background. Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood. Patients and Methods. Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing. Results. Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 (r = -0.65, P < 0.001) or L3-L4 (r = -0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4- L5 (r = -0.42, P < 0.001) and at L3-L4 (r = -0.44, P < 0.001) Conclusion. At 6 months after a lumbar interbody fusion at L5- S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the change in pressure on the cage during compression manipulation in lumbar interbody fusion. While the procedure involves applying compression between pedicle screws to press the cage against the endplate, the exact compression force remains elusive. We hypothesize that an intact facet joint might serve as a fulcrum, potentially reducing cage pressure. Pressure on the intervertebral disc cage was measured during compression manipulation in 4 donor cadavers undergoing lumbar interbody fusion. Unilateral facetectomy models with both normal and parallel compression and bilateral facetectomy models were included. A transforaminal lumbar interbody fusion cage with a built-in load cell measured the compression force. Pressure data from 14 discs indicated a consistent precompression pressure average of 68.16 N. Following compression, pressures increased to 125.99 N and 140.84 N for normal and parallel compression postunilateral facetectomy, respectively, and to 154.58 N and 150.46 N for bilateral models. A strong linear correlation (correlation coefficient: 0.967, P < 0.0001) between precompression and postcompression pressures emphasized the necessity of sufficient precompression pressure for achieving desired postcompression outcomes. None of the data showed a decrease in compression force to the cage with the compression maneuver. Both normal and parallel compression maneuvers effectively increased the pressure on the cage, irrespective of the facet joint resection status. Compression manipulation consistently enhanced compressive force on the cage. However, when baseline pressure is low, the manipulation might not yield significant increases in compression force. This underlines the essential role of meticulous precompression preparation in enhancing surgical outcomes. [ABSTRACT FROM AUTHOR]

Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are well-established procedures for spinal fusion. However, little is known about load sharing between cage, dorsal construct, and biological tissue within the instrumented lumbar spine. The aim of this study was to quantify the forces acting on cages under axial compression force with and without posterior instrumentation. Biomechanical cadaveric study. Ten lumbar spinal segments were tested under uniaxial compression using load cell instrumented intervertebral cages. The force was increased in 100N increments to 1000N or a force greater than 500N on one load cell. Each specimen was tested after unilateral PLIF (uPLIF), bilateral PLIF (bPLIF) and TLIF each with/without posterior instrumentation. Dorsal instrumentation was performed with 55N of compression per side. Cage insertion resulted in median cage preloads of 16N, 29N and 35N for uPLIF, bPLIF, and TLIF. The addition of compressed dorsal instrumentation increased the median preload to 224N, 328N, and 317N, respectively. With posterior instrumentation, the percentage of the external load acting on the intervertebral cage was less than 25% at 100N (uPLIF: 14.2%; bPLIF: 16%; TLIF: 11%), less than 45% at 500N (uPLIF: 31.8%; bPLIF: 41.1%; TLIF: 37.9%) and less than 50% at 1000N (uPLIF: 40.3%; bPLIF: 49.7%; TLIF: 43.4%). Without posterior instrumentation, the percentage of external load on the cages was significantly higher with values above 50% at 100N (uPLIF: 55.6%; bPLIF: 75.5%; TLIF: 66.8%), 500N (uPLIF: 71.7%; bPLIF: 79.2%; TLIF: 65.4%), and 1000N external load (uPLIF: 73%; bPLIF: 80.5%; TLIF: 66.1%). For absolute loads, preloads and external loads must be added together. Without posterior instrumentation, the intervertebral cages absorb more than 50% of the axial load and the load distribution is largely independent of the loading amplitude. With posterior instrumentation, the external load acting on the cages is significantly lower and the load distribution becomes load amplitude dependent, with a higher proportion of the load transferred by the cages at high loads. The bPLIF cages tend to absorb more force than the other two cage configurations. Cage instrumentation allows some of the compression force to be transmitted through the cage to the screws below, better distributing and reducing the overall force on the pedicle screws at the end of the construct and on the rods. [ABSTRACT FROM AUTHOR]

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery. [ABSTRACT FROM AUTHOR]

The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin's Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement. [ABSTRACT FROM AUTHOR]

Background: Recombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown. Objective: To assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP. Methods: This was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and Ω2 analyses, and perioperative characteristics were analyzed by multiple logistic regression. Results: One hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis. Conclusions: BMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis. Clinical Relevance: BMP is frequently used "off-label" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure. [ABSTRACT FROM AUTHOR]

Background: There is an increasing acceptance of conducting minimally invasive transforaminal lumbar interbody fusion (TLIF) in ambulatory surgical centers (ASCs). The Centers for Medicare and Medicaid Services (CMS) introduced the Hospitals Without Walls (HWW) program in March 2020. This program granted hospitals regulatory flexibility to offer services and procedures in nontraditional locations, including ASCs. However, implementation hurdles persist. Methods: A survey was sent to 235 surgeons regarding the use of ASCs for performing TLIF surgeries on elderly patients. Multiple-choice questions covering various aspects of TLIF practice preferences, including surgical indications, decision factors for choosing ASCs over hospitals, implementation hurdles, reimbursement concerns, staffing issues, and the impact of CMS rules and regulations on TLIF in ASCs, particularly concerning physician ownership and self-referral conflicts governed by the Stark law, were asked. Results: The survey completion rate was 25.8% (Figure 1). The most common surgical indications for TLIF in ASCs were spondylolisthesis (80%), spinal stenosis (62.5%), and low back pain (47.5%). Most surgeons (78%) believed TLIF could be safely performed in ASCs. Streamlined workflow, lower infection rates, and cost-effectiveness were advantages listed by 58.5% of surgeons. Patient's medical history (75.8%), followed by ASC resources and capabilities (61%) and surgeon preference (61%), were relevant factors. Higher efficiencies at ASCs (14.6%), contractual issues (9.8%), and ownership issues (7.3%) were less relevant to surgeons. About 65.9% of surgeons reported lower reimbursement in ASCs, and 43.9% said it was an implementation hurdle. Lower direct costs were reported by 53.7% of surgeons. Other hurdles included a lack of trained staff (24.4%), inadequate staffing (22.0%), cost overruns (26.8%), high Joint Commission or the Accreditation Association for Ambulatory Health Care credentialing costs, and surgeons feeling uncomfortable performing TLIF in ASCs (22.0%). Only 17.1% listed medical problems as a reason their patient was considered unsuitable for the ASC environment. A majority (53.7%) stated that their ASCs complied with strict Stark requirements by disclosing physician ownership interests. However, 22% of surgeons reported self-referrals under the "In-Office Ancillary Services Exception" allowed by the Stark law. Conclusion: Our survey data show that surgeons' perceptions of current CMS rules and regulations may hinder the transition into the ASC setting because they think the reimbursement is too low and the regulatory burden is too high. ASCs have disproportionally higher initial acquisition and ongoing costs related to staff training and maintenance of the TLIF technology that CMS should consider when determining the appropriate financial remuneration for these complex procedures. Clinical Relevance: ASC offers a viable and attractive option for their TLIF procedure with the advantage of same-day discharge and at-home recovery. [ABSTRACT FROM AUTHOR]

Background: A wide variety of materials are used for lumbar interbody fusion, but there is no unified consensus on the superiority of one material over another. The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the various TLIF interbody materials based on fusion rates. Methods: We queried PubMed, EMBASE and Scopus from inception until August 2023, in which 2135 studies were identified. Inclusion criteria were applied based on the PRISMA guidelines. The fusion assessment employed the Bridwell's criteria with a length of follow-up of at least 12 months. The NMA was conducted to compare multiple approaches from multiple studies using the frequentist framework with STATA16. Results: In total, 13 TLIF studies involving 1919 patients with 1981 lumbar interbody levels fulfilled our eligibility criteria. Seven different cage materials were utilized: polyetheretherketone (PEEK, as the reference), allograft, autograft, PEEK with titanium coating (TiPEEK), titanium, carbon/carbon fiber reinforced polymer (CFRP) and 3D-printed titanium. The average patient age was 60.9 (SD = 7.5) years old. When compared to PEEK, the other six materials did not have a significantly different rate of lumbar fusion. However, the SUCRA number of the 3D-printed titanium, TiPEEK, Ti, allograft, autograft, CFRP, and PEEK were 0.8, 0.6, 0.5, 0.5, 0.4, 0.4, and 0.3 consecutively. Conclusions: Based on a network meta-analysis within the confines of our clinical study, 3D-printed titanium interbody cage may promote the highest success rate of fusion while PEEK may be the material with the least success rate of fusion in TLIF.

Background: Robotic-assisted, endoscopic transforaminal lumbar interbody fusion (RE-TLIF) is a promising, minimally invasive surgical option for degenerative lumbar spondylosis/spondylolisthesis; however, outcomes data and efficacy are limited, especially in multilevel disease. Here, we present the first reported series of patients that underwent either single or multilevel RE-TLIF. Methods: A retrospective review was performed on 23 consecutive patients who underwent a single level or multilevel RE-TLIF by a single surgeon. Variables included demographics, perioperative results, pain scores, and functional outcome scores. Results: Eighteen patients (78.3 %) underwent single level RE-TLIF and 5 patients (21.7 %) underwent multilevel RE-TLIF. The median reduction of visual analog scale (VAS) for low back pain (LBP) of all subjects was 6 (IQR = 4.5, 6.5) with no significant difference between single level and multilevel RE-TLIF (p = 0.565). The median reduction of VAS for leg pain of all subjects 7 (IQR = 6, 8) with no significant difference between single level and multilevel RE-TLIF (p = 0.702). Median blood loss was 25 cc (IQR = 25, 25) and 50 cc (IQR = 25, 100) for single and multilevel RE-TLIF, respectively (p = 0.025), whereas median length of stay was 1 (IQR = 1, 1; mean = 1.0 ± 00.18) days and 1 (IQR = 1, 2; mean = 1.4 ± 00.54) days, respectively (p = 0.042). One major complication was observed requiring reoperation for demineralized bone matrix migration resulting in an L5 radiculopathy. Conclusions: Single and multi-level RE-TLIF appears to be a safe and efficacious approach with comparable outcomes to open and other minimally invasive approaches. Additionally, we observed favorable accuracy in robot-assisted pedicle screw, endoscope, and interbody device placement.

Purpose: This study aimed to compare the functional and radiographic outcomes of two surgical interventions for adult spinal deformity (ASD): anterior lumbar interbody fusion with anterior column realignment (ALIF-ACR) and posterior approach using Smith–Peterson osteotomy with transforaminal lumbar interbody fusion and pedicle screw fixation (TLIF-Schwab2). Methods: A retrospective cohort study included 61 ASD patients treated surgically between 2019 and 2020 at a single tertiary orthopedic specialty hospital. Patients were divided into two groups: Group 1 (ALIF-ACR, 29 patients) and Group 2 (TLIF-Schwab2, 32 patients). Spinopelvic radiographic parameters and functional outcomes were evaluated at 3, 6, and 12 months postsurgery. Results: Perioperative outcomes favored the ALIF-ACR group, with significantly smaller blood loss, shorter hospital stay, and operative time. Radiographic and functional outcomes were similar for both groups; however, the ALIF-ACR group did have a greater degree of correction in lumbar lordosis at 12 months. Complication profiles varied, with the ALIF-ACR group experiencing mostly hardware-related complications, while the TLIF-Schwab2 group faced dural tears, wound dehiscence, and proximal junctional kyphosis. Both groups had similar revision rates. Conclusion: Both ALIF-ACR and TLIF-Schwab2 achieved similar radiographic and functional outcomes in ASD patients with moderate sagittal plane deformity at 1-year follow-up. However, the safety profiles of the two techniques differed. Further research is required to optimize patient selection for each surgical approach, aiming to minimize perioperative complications and reoperation rates in this challenging patient population. [ABSTRACT FROM AUTHOR]

• We identify how radiographic parameters can be expected to change following TLIF. • We create a reference for surgeons to aim for in correcting spinal deformity in adults. • Non-revision patients experienced durable improvement in three key radiographic parameters. • Revision patients experienced improvement post-operatively, but reverted during follow-up. The expected post-operative changes in radiographic alignment over time remain poorly defined in patients surgically treated for degenerative scoliosis without instrument failure. Here we aim to describe the optimal natural progression of radiographic degenerative scoliosis at multiple timepoints in patients treated with a transforaminal lumbar interbody fusion (TLIF). We identified an initial retrospective cohort of 114 patients treated with a TLIF for degenerative scoliosis between 2018 and 2022, with 39 patients ultimately meeting the imaging inclusion criteria. Patients who completed a primary or revision procedure with no evidence of instrument failure, proximal junctional kyphosis, or proximal junctional failure at last follow-up were included. Radiographic measurements of spinopelvic alignment were manually extracted from X-Ray scoliosis films. Thirty-nine patients (mean age 62.6 ± 8.7, mean follow-up 2.9 years), of which 23 underwent a primary TLIF (Primary) and 16 a revision procedure (Revision), were analyzed. Patients in the Primary group experienced a durable improvement in Thoracolumbar Cobb angle (-25° ± 15°), Thoracic Kyphosis (10° ± 13°), and Pelvic Incidence/lumbar lordosis mismatch (PI/LL) (-19° ± 19°) through the first year of follow-up. In the Revision group, at one year follow-up, all measures of spinopelvic alignment except PI/LL mismatch had reverted to pre-operative levels. Thoracolumbar Cobb angle decreased to a significantly greater degree in the Primary group compared to the Revision group. Primary TLIF operations without instrument failure consistently improve radiographic outcomes in three key measures through the first year. For revision procedures, there appears to be modest radiographic benefit at follow-up. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study is to conduct a bibliometric analysis to examine the current condition, areas of interest, and rising trends of transforaminal lumbar interbody fusion in lumbar spine surgery (TLIF), as well as its importance in associated research domains. MATERIALS AND METHODS: An extensive collection of academic papers on the use of TLIF was obtained from the Web of Science between January 1, 2000, and November 5, 2023. Then, using a variety of tools like HisCite, VOSviewer, CiteSpace, and the bibliometrix package, a bibliometric study was carried out. This study included the collection of information on country, institution, author, journal, and keywords. RESULTS: A comprehensive analysis was undertaken on a total of 1,907 publications obtained from 181 journals, encompassing the contributions of 7,232 authors affiliated with 1,775 institutes spanning 57 countries/regions. Notably, the USA exhibited the highest number of publications, with 763 (40.03%) articles on TLIF. The most productive institution was Rush University, with 96 (5.03%) publications. The author with the highest publication output was Singh, Kern with 75 (3.93%) publications. World Neurosurgery demonstrated the highest level of productivity, having published a total of 211 (11.06%) articles. The most frequently used keywords were "TLIF", "spondylolisthesis" and "complication". Meanwhile, "workflow", "technical note" and "hidden blood loss" have been identified as the research frontiers for the forthcoming years. CONCLUSIONS: This paper provides a thorough evaluation of current research trends and advancements in TLIF. It includes relevant research findings and emphasizes collaborative efforts among authors, institutions, and countries. [ABSTRACT FROM AUTHOR]

Background In this study, we evaluate the clinical efficacy and safety of full-endoscopic transforaminal lumbar interbody fusion (TLIF) for treatment of single-level lumbar degenerative spondylolisthesis. Methods Fifty-three patients were divided into two groups according to the surgical techniques: Full endoscopic (Endo)-TLIF (n = 25) and TLIF (n = 28). Clinical efficacy was evaluated pre- and postoperatively. The operation time, operative blood loss, postoperative amount of serum creatine phosphokinase (CPK), postoperative drainage volume, postoperative hospital stay time, total cost, and operative complications were also recorded. Results Compared with the TLIF group, the Endo-TLIF group had similar intraoperative blood loss, less postoperative increased CPK, less postoperative drainage volume, and shorter postoperative hospital stay, but longer operative time and higher total cost. The postoperative visual analog scale (VAS) scores of back and leg pain and Oswestry Disability Index (ODI) scores significantly improved compared with the preoperative scores in both two groups; more significant improvement of postoperative VAS scores of back pain and ODI scores were shown in the Endo-TLIF group at the 1-month follow-up (p < 0.05). No difference was found in the intervertebral fusion rate between the two groups. Conclusion The Endo-TLIF has similar clinical effect compared with the TLIF for the treatment of lumbar degenerative spondylolisthesis. It also has many surgical advantages such as less muscle trauma, less postoperative back pain, and fast functional recovery of the patient. However, steep learning curve, longer operative time, and higher total cost may be the disadvantages that limit this technique. Also, the Endo-TLIF treatment of patients with bilateral lateral recess stenosis is considered a relative contraindication. [ABSTRACT FROM AUTHOR]

The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection. [ABSTRACT FROM AUTHOR]

BackgroundThere currently exists some controversy about the efficacy of oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.AimThis study compares the application effects of OLIF and TLIF in lumbar degenerative diseases by reviewing the literature and using meta-analysis.MethodsWe included randomized controlled trials and cohort studies comparing TLIF and OLIF in the treatment of lumbar degenerative diseases. We searched for words such as “intervertebral disc degeneration,” “spinal fusion,” and “lumbar vertebrae” in the PubMed, Embase, and Cochrane Library databases. The search date was set from the establishment date of the database to October 2023. Two authors independently conducted document screening, data abstraction, and qualitative assessment. A meta-analysis was performed and adapted to RevMan5.3 software. The odds ratio (OR), weighted mean difference (WMD), and 95% CI were calculated by adopting a fixed-effect model (FEM) or a random-effect model (REM).ResultsA total of 18 cohort studies were included with 1,550 patients, of whom 806 patients underwent TLIF (TLIF group) and 744 patients underwent OLIF (OLIF group). There were no significant differences found in the fusion rate [OR = 1.58 (0.95, 2.64), P = 0.08], complication rate [OR = 1.25 (0.93, 1.68), P = 0.14], and visual analog scale for back pain (VAS-BP) [WMD = 0.00 (−0.13, 0.14), P = 0.96] between the two groups. Compared with the TLIF group, the OLIF group had a lower Oswestry disability index (ODI) [WMD = −0.62 (−1.03, −0.20), P = 0.003], a higher foramen height (FH) [WMD = 2.03 (1.42, 2.46), P

Purpose: Transforaminal lumbar interbody fusion (TLIF) is a classic surgical procedure for posterior lumbar fusion. This study aims to analyze the TLIF field by bibliometric method and comprehensively summarize the research status and trends. Methods: All TLIF-related articles were retrieved from the Web of Science. The data were analyzed using R software and SPSS to calculate corresponding indicators. Visualizations were drawn using VOSviewer and Scimago Graphica, including country, institution, journal, author, and keywords. Results: A total of 919 articles were included. The annual publication volume of TLIF-related articles presented an exponential growth. North America, Europe, and Asia were the main sources of articles, with the USA and China being the main contributors and the USA being the global research center for TLIF. The level of the national economy was an important factor affecting TLIF-related research. The highest number of contributions in this field was made by Kern Singh among authors and by Rush University among institutions. The European Spine Journal was the most influential journal. The research focus has gradually shifted from perfecting the TLIF technique toward emphasizing the patient level. The improvement of minimally invasive techniques and how to improve clinical outcomes as well as accelerate postoperative rehabilitation of patients may be the hot spot of future research. Conclusions: With the advancement of medical technology and the popularization of minimally invasive concepts in recent years, TLIF and its derivative technologies have attracted increasing attention. Patient-centered minimally invasive surgery is a hot research topic in the field of TLIF currently and will continue to be so into the future

Abstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of

Posterior and transforaminal lumbar interbody fusion (PLIF and TLIF) allow some variation between surgeons, particularly regarding the extent of resection of the posterior interspinous ligamentary complex (PILC) with uncertain implications for outcome. The aim of this study was to assess the importance of preserving the PILC when performing PLIF or TLIF. Systematic review of clinical outcomes (adjacent segment degeneration (ASDG), fusion rate, reoperation rate, and visual analog scale (VAS) scores for back and leg pain) after PLIF/TLIF matched for integrity of PILC, Oswestry Disability Index (ODI) score, and radiological parameters. A total of 191 patients from 2 studies (1 prospective randomized control trial (RCT) and 1 retrospective observational cohort study) were identified. 102 (53.4%) had fusion (PLIF/TLIF) with preserved PILC. All 120 patients in the RCT underwent a L4–L5 single-level fusion, while the 71 patients in the retrospective cohort underwent surgery between T11 and S1. In the retrospective cohort study, significant differences between groups in mean number of fixed levels (4.8 ± 1.0 vs. 4.2 ± 0.5), decompressed levels (2.4 ± 0.7 vs. 3.0 ± 0.7), and interbody fusions (1.2 ± 0.9 vs. 2.0 ± 1.0) were reported. In each of the studies, all groups reported an improved ODI score at 3 months after surgery and at last follow-up. In each of the studies, the incidence of radiographic ASDG was significantly higher for the PILC resection group in both studies (9.0% vs. 43.0%, p < 0.01 and 23.0% vs. 49.0%, p = 0.042). Lumbar lordosis (which decreased after PILC resection in the RCT, p < 0.05) also differed between groups. Taken as a whole, these results suggest that preservation of the PILC during PLIF/TLIF surgery prevents future ASDG and loss of lumbar lordosis as well as the potential clinical consequences of these changes. Further prospective studies are needed.

Background: The aim of this study is to compare the surgical outcomes of two different surgical approaches, open transforaminal lumbar interbody fusion (TLIF) and Wiltse TLIF, in the treatment of single-level lumbar spondylolisthesis and also to provide the advantages and disadvantages of each approach. Methods: This retrospective study included 600 patients with single-level lumbar spondylolisthesis who underwent fusion surgery at a single academic institution between January 2018 and December 2022. Patients were divided into two groups: traditional open TLIF (group A; 300 patients) and the Wiltse TLIF approach (group B; 300 patients). Preoperative diagnostic tests were performed on all patients. Results: The fluoroscopy time for the Wiltse TLIF group was longer, whereas the mean blood loss for the Wiltse TLIF approach was less. Both techniques resulted in significant improvements in pain relief and functional disability, with no significant difference between the two groups in terms of their pre- or post-operative (Oswestry Disability Index) ODI scores. The Wiltse TLIF technique resulted in significantly shorter hospital stays and had a lower rate of complications compared with the open TLIF technique. Conclusion: The Wiltse TLIF approach showed advantages in shorter surgical times, reduced blood loss, and shorter hospital stays, whereas the traditional open TLIF approach exhibited shorter fluoroscopy times.

Abstract Background Osteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated. Results Sixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores. Conclusions VP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures.

Abstract Study design This was a retrospective study. Objectives Adjacent segment degeneration (ASD) is a major complication associated with spinal fusion. The lumbar paraspinal muscle is an essential factor influencing the occurrence of ASD. This study aimed to investigate the effect of preoperative lumbar paraspinal muscle quality on L5-S1 adjacent lumbar foraminal stenosis degeneration (ASLFSD) after L4–5 transforaminal lumbar interbody fusion (TLIF). Methods A total of 113 patients diagnosed with lumbar spinal stenosis at L4–5 were treated with TLIF. Lumbar paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The measurements included the total cross-sectional area of psoas (PS-tCSA), of erector spinae (ES-tCSA), and of multifidus (MF-tCSA); and fatty infiltration of psoas (PS-FI), of erector spinae (ES-FI), and of multifidus (MF-FI). Foraminal measurements, including posterior disc height (PDH), disc-to-facet distance (D–F), foraminal height (FH), and foraminal area (FA), were obtained bilaterally using a computed tomography system. The association between lumbar paraspinal muscle quality and changes in foraminal measurements was also studied. Results We observed that the FH and FA significantly reduced at 1 year postoperatively at the mean follow-up period of 41.56 ± 8.38 months (range, 43–50 months), and PDH, D–F, FH, and FA all significantly reduced at final follow-up. These changes in foraminal measurements were significantly and negatively correlated with PS-FI, ES-FI, and MF-FI. Conclusion During the clinical follow-up, we found that patients with a higher degree of paraspinal muscle FI were more likely to develop L5-S1 ASLFSD after L4–5 TLIF.

Objective Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. Methods Ninety‐six patients who underwent single‐level L5‐S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan–Steffee–Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow‐up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t‐test or chi‐square test. Results The mean follow‐up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow‐up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow‐up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p 0.999). Conclusions With a minimum 2‐year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.

There are a wide variety of interbody devices available for use in transforaminal lumbar interbody fusion (TLIF). While traditionally these interbodies are bullet-shaped, crescent-shaped cages have become increasingly common. There is a paucity of literature comparing the effect of cage geometry with substratification for surgical approach (minimally invasive (MIS) vs. open). The aim of this study was to determine the effect of implant geometry, positioning, and surgical approach on the correction of different spinal alignment parameters in patients undergoing TLIF. A retrospective chart and imaging review was performed on 103 patients with a total of 131 instrumented segments performed by a single surgeon. Preoperative, initial postoperative, and final postoperative standing lateral lumbar radiographs were evaluated for lumbar lordosis (LL), segmental lordosis (SL), anterior disc height (ADH), and posterior disc height (PDH). Anterior-posterior implant positioning was recorded for initial and final postoperative radiographs. These measurements were compared among four groups: open bullet (OB), MIS bullet (MB), open crescent (OC), and MIS crescent (MC). SL increased in all groups by a mean of 2.9° at initial imaging and 2.2° at final imaging. The OC group had greater initial improvement in SL compared to the MB group (p = 0.02), though this effect was lost at final follow-up (p = 0.11). The OB and OC groups conferred greater initial improvement in ADH (p = 0.02; p = 0.04), while the OC group had greater final improvement in ADH compared to the MB and MC groups (p = 0.01; p = 0.01). The OC group had less initial improvement in PDH compared with the other groups (p = 0.03, p = 0.02, p < 0.01). The MB group provided greater final improvement in PDH compared with the MC and OC groups (p = 0.04, p = 0.01). Cage geometry, surgical approach, and implant position all demonstrated a statistically significant but clinically minor impact on segmental alignment for TLIF procedures.

ABSTRACT: Background: Anterior lumbar interbody fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF) may be used to correct the lumbosacral fractional curve (LsFC) in de novo adult (thoraco) lumbar scoliosis. Yet, the relative benefits of ALIF and TLIF for LsFC correction remain largely undetermined. Purpose: To compare the currently available data comparing radiographic correction of the LsFC provided by ALIF and TLIF of LsFC in adult (thoraco)lumbar scoliosis. Methods: A systematic review was performed on original articles discussing fractional curve correction of lumbosacral spinal deformity (using search criteria: “lumbar” and “fractional curve”). Articles which discussed TLIF or ALIF for LsFC correction were presented and radiographic results for TLIF and ALIF were compared. Results: Thirty-one articles were returned in the original search criteria, with 7 articles included in the systematic review criteria. All 7 articles presented radiographic results using TLIF for LsFC correction. Three of these articles also discussed results for patients whose LsFC were treated with ALIFs; 2 articles directly compared TLIF and ALIF for LsFC correction. Level III and level IV evidence indicated ALIF as advantageous for reducing the coronal Cobb angle of the LsFC. There were mixed results on relative efficacy of ALIF and TLIF in the LsFC for restoration of adequate global coronal alignment. Conclusions: Limited level III and IV evidence suggests ALIF as advantageous for reducing the coronal Cobb angle of the LsFC in de novo adult (thoraco) lumbar scoliosis. Relative efficacy of ALIF and TLIF in the LsFC for restoration of global coronal alignment may be dictated by several factors, including directionality and magnitude of preoperative coronal deformity. Given the limited and low-quality evidence, additional research is warranted to determine the ideal interbody support strategies to address the LsFC in adult (thoraco) lumbar scoliosis.

Background: Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods: Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of < 5 mm. The average follow-up duration was 30 months. Results: We achieved excellent clinical results, with only four cases of failure (5.2%). Moreover, we noticed a statistically significant redistribution of lumbar lordosis, with an average percentage increase in L4–S1 lordosis equal to 19.9% (P < 0.001), an average increase in the L4–S1/Lumbar lordosis (LL) ratio from 0.53 to 0.63 (P < 0.001), and a mean percentage increase in sacral slope equal to 7.6% (P < 0.001). Conclusion: Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures. Level of evidence: 4 Trial registration statement: retrospective observational study, no trial registration. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to compare the surgical outcomes of two different surgical approaches, open transforaminal lumbar interbody fusion (TLIF) and Wiltse TLIF, in the treatment of single-level lumbar spondylolisthesis and also to provide the advantages and disadvantages of each approach. Methods: This retrospective study included 600 patients with single-level lumbar spondylolisthesis who underwent fusion surgery at a single academic institution between January 2018 and December 2022. Patients were divided into two groups: traditional open TLIF (group A; 300 patients) and the Wiltse TLIF approach (group B; 300 patients). Preoperative diagnostic tests were performed on all patients. Results: The fluoroscopy time for the Wiltse TLIF group was longer, whereas the mean blood loss for the Wiltse TLIF approach was less. Both techniques resulted in significant improvements in pain relief and functional disability, with no significant difference between the two groups in terms of their pre- or post-operative (Oswestry Disability Index) ODI scores. The Wiltse TLIF technique resulted in significantly shorter hospital stays and had a lower rate of complications compared with the open TLIF technique. Conclusion: The Wiltse TLIF approach showed advantages in shorter surgical times, reduced blood loss, and shorter hospital stays, whereas the traditional open TLIF approach exhibited shorter fluoroscopy times. [ABSTRACT FROM AUTHOR]

Posterior and transforaminal lumbar interbody fusion (PLIF and TLIF) allow some variation between surgeons, particularly regarding the extent of resection of the posterior interspinous ligamentary complex (PILC) with uncertain implications for outcome. The aim of this study was to assess the importance of preserving the PILC when performing PLIF or TLIF. Systematic review of clinical outcomes (adjacent segment degeneration (ASDG), fusion rate, reoperation rate, and visual analog scale (VAS) scores for back and leg pain) after PLIF/TLIF matched for integrity of PILC, Oswestry Disability Index (ODI) score, and radiological parameters. A total of 191 patients from 2 studies (1 prospective randomized control trial (RCT) and 1 retrospective observational cohort study) were identified. 102 (53.4%) had fusion (PLIF/TLIF) with preserved PILC. All 120 patients in the RCT underwent a L4–L5 single-level fusion, while the 71 patients in the retrospective cohort underwent surgery between T11 and S1. In the retrospective cohort study, significant differences between groups in mean number of fixed levels (4.8 ± 1.0 vs. 4.2 ± 0.5), decompressed levels (2.4 ± 0.7 vs. 3.0 ± 0.7), and interbody fusions (1.2 ± 0.9 vs. 2.0 ± 1.0) were reported. In each of the studies, all groups reported an improved ODI score at 3 months after surgery and at last follow-up. In each of the studies, the incidence of radiographic ASDG was significantly higher for the PILC resection group in both studies (9.0% vs. 43.0%, p < 0.01 and 23.0% vs. 49.0%, p = 0.042). Lumbar lordosis (which decreased after PILC resection in the RCT, p < 0.05) also differed between groups. Taken as a whole, these results suggest that preservation of the PILC during PLIF/TLIF surgery prevents future ASDG and loss of lumbar lordosis as well as the potential clinical consequences of these changes. Further prospective studies are needed. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of prospectively collected multisurgeon data. Objective. Examine the rate, clinical impact, and predictors of subsidence after expandable minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) cage. Summary of Background Data. Expandable cage technology has been adopted in MI-TLIF to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as the force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence. Materials and Methods. Patients who underwent 1 or 2-level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of >1 year were included. Preoperative and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by >25% compared with the immediate postoperative value. Patient-reported outcomes were collected and analyzed for differences at the early (< 6 mo) and late (>6 mo) time points. Fusion was assessed by 1-year postoperative computed tomography. Results. One hundred forty-eight patients were included (mean age, 61 yr, 86% 1-level, 14% 2-level). Twenty-two (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, had lower bone mineral density, and had higher body mass index and comorbidity burden. Operative time was significantly higher (P = 0.02) and implant width was lower (P < 0.01) for subsided patients. Visual analog scale-leg was significantly lower for subsided patients compared with nonsubsided patients at a > 6 months time point. Long-term (>6 mo) patient-acceptable symptom state achievement rate was lower for subsided patients (53% vs. 77%), although statistically not significant (P = 0.065). No differences existed in complication, reoperation, or fusion rates. Conclusions. Of the patients, 14.9% experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most patient-reported outcome measures and complication, reoperation, or fusion rates, patients had lower visual analog scale-leg and patient-acceptable symptom state achievement rates at the > 6-month time point. [ABSTRACT FROM AUTHOR]

Background: This review seeks to investigate the clinically relevant bone graft materials in single-level transforaminal lumbar interbody fusion (TLIF) procedures as defined by (1) primary outcomes (ie, fusion rates and complication rates) and (2) patient-reported outcomes (ie, visual analog scale [VAS] and Oswestry disability index [ODI]). Because of the advantages in stimulating bone growth, autologous bone grafts such as the iliac crest bone graft (ICBG) have been the gold standard. Numerous alternatives to ICBG have been introduced. Understanding the risks and benefits of bone graft options is vital to optimizing patient care. Methods: A PubMed search was performed for all clinical studies published between January 2008 and March 2023 that referenced the single-level TLIF procedure as well as one of the following grafts: autograft, allograft, bone morphogenetic protein (BMP), demineralized bone matrix, or mesenchymal stem cells (MSCs). Case studies and reports were excluded. Results: Twenty-eight studies met the inclusion criteria. Studies from the PubMed search demonstrated similarly high fusion rates across nearly all graft materials, the lone exception being MSCs, which showed lower fusion rates. ICBG grafts experienced higher rates of postoperative graft site pain. The BMP graft material had high rates of radiculitis, heterogeneous ossification, and vertebral osteolysis. Patients saw an overall improvement in VAS and ODI scores with all graft materials. Conclusion: Local autografts and ICBG have been the most studied. Fusion rates during single-level TLIF were similar across all graft materials except MSCs. Patient-reported pain levels improved after TLIF surgery regardless of the type of grafts used. While BMP implants have shown promising benefits, they have introduced a new array of complications not normally seen in ICBG implants. The study is limited by the lack of evidence of certain graft materials as well as nonuniformity in metrics evaluating the efficacy of graft materials. [ABSTRACT FROM AUTHOR]

Retrospective Multi-Institutional Database Study. Investigate the effect of metabolic syndrome (MetS) on the outcomes of Transforaminal Lumbar Interbody Fusion (TLIF) TLIF procedures in lumbar spine pathology are common. MetS is a combination of conditions, including medication required hypertension, diabetes mellitus (DM), and body mass index (BMI) of 30 kg/m2s or more. The prevalence of MetS has increased drastically over the past two decades. Our study aimed to understand the effect of MetS on morbidity and mortality of TLIF postoperatively. Our study used American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) data from 2006 to 2019 to find all patients who underwent TLIF. Patients with MetS were compared to those without MetS. Fisher's test identified univariate relationships between MetS and preoperative/postoperative variables. Multivariable logistic regression models were utilized to analyze the association between MetS and postoperative morbidity and mortality. 54,980 patients were identified who received TLIF. 10.7 % had MetS preoperatively. Patients with and without MetS showed statistically significant univariate differences in most preoperative and postoperative variables. After adjusting for preoperative comorbidities, patients with MetS had greater multivariate-adjusted odds of wound infections (aOR = 1.5889, CI 1.1952–2.112, p = 0.00144), pulmonary events (aOR = 1.5517, CI 1.1207–2.1485, p = 0.00813), renal events (aOR = 2.8685, CI 1.5511–5.3045, p = 0.00078), sepsis (aOR = 1.6773, CI 1.1647–2.4155, p = 5.44E-03), and return to OR (aOR = 1.4764, CI 1.2201–1.7866, p = 6.19E-05) Patients with MetS are at elevated risk for various morbidity and mortality markers after TLIF. Surgeons performing TLIFs on these patients should be aware of the increased potential for postoperative events that may complicate the patient's recovery. Level III. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of prospectively collected data. Objective. To analyze the learning curves of three spine surgeons for robotic minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although the learning curve for robotic MI-TLIF has been described, the current evidence is of low quality with most studies being single-surgeon series. Materials and Methods. Patients who underwent single-level MI-TLIF with three spine surgeons (years in practice: surgeon 1: 4, surgeon 2: 16, and surgeon 3: two) using a floor-mounted robot were included. Outcome measures were operative time, fluoroscopy time, intraoperative complications, screw revision, and patientreported outcome measures. Each surgeon's cases were divided into successive groups of 10 patients and compared for differences. Linear regression and cumulative sum (CuSum) analyses were performed to analyze the trend and learning curve, respectively. Results. A total of 187 patients were included (surgeon 1: 45, surgeon 2: 122, and surgeon 3: 20). For surgeon 1, CuSum analysis showed a learning curve of 21 cases with the attainment of mastery at case 31. Linear regression plots showed negative slopes for operative and fluoroscopy time. Both learning phase and postlearning phase groups showed significant improvement in patient-reported outcome measures. For surgeon 2, CuSum analysis demonstrated no discernible learning curve. There was no significant difference between successive patient groups in either operative time or fluoroscopy time. For surgeon 3, CuSum analysis demonstrated no discernible learning curve. Even though the difference between successive patient groups was not significant, cases 11 to 20 had an average operative time of 26 minutes less than cases 1-10), suggesting an ongoing learning curve. Conclusions. Surgeons who are well-experienced can be expected to have no or minimal learning curve for robotic MI-TLIF. Early attendings are likely to have a learning curve of around 21 cases with the attainment of mastery at case 31. Learning curve does not seem to impact clinical outcomes after surgery. [ABSTRACT FROM AUTHOR]

Cage subsidence following transforaminal lumbar interbody fusion (TLIF) has closely correlated with poor vertebral bone quality. Studies have shown better predictive value for cage subsidence by measuring bone density at specific site. However, few studies have been performed to examine the relationship between site-specific MRI bone assessment and cage subsidence in patients who have undergone lumbar interbody fusion. The association between MRI-based assessment of endplate bone quality and cage subsidence after TLIF remains unclear. To study the predictive value of MRI-based endplate bone quality (EBQ) score for cage subsidence following TLIF, using QCT bone densitometry as a reference standard. A retrospective study. A total of 280 adult patients undergoing single-segment TLIF for degenerative lumbar spine disease from 2010 to 2020 at our institution who had preoperative T1-weighted MRIs. Cage subsidence, disc height, endplate bone quality (EBQ) score, bone mineral density, fusion rate. The retrospective study reviewed patients who underwent TLIF at one institution between March 2010 and October 2020. Cage subsidence was measured with postoperative lumbar X-rays based on the cage protrusion through into the superior or inferior end plate or both by more than 2 mm. The EBQ score was measured from preoperative T1-weighted MRI in accordance with the previously reported method. Cage subsidence was observed in 42 of the 280 patients. Bone densitometry with quantitative computed tomography was visibly reduced in the subsidence group. The mean EBQ scores of the lumbar endplate bone was 4.3±0.9 in nonsubsidence and 5.0±0.6 in subsidence. On multivariate logistic regression, the difference between the two groups was remarkable. Risk of cage subsidence increases significantly with higher EBQ scores (odds ratio [OR]=2.063, 95% confidence interval [CI] 1.365–3.120, p=.001) and was an independent factor in predicting subsidence after TLIF. On receiver operating characteristic curve, the AUC for the EBQ score was 0.820 (95% confidence interval [CI]: 0.755–0.844) and the most suitable threshold for the EBQ score was 4.730 (sensitivity: 76.2%, specificity: 83.2%). Higher EBQ scores measured on preoperative MRI correlated significantly with cage subsidence following TLIF. Performing EBQ assessment prior to TLIF may be a valid method of predicting the risk of postoperative subsidence. [ABSTRACT FROM AUTHOR]

Background and Objective: There is a paucity of literature comparing unilateral instrumented transforaminal lumbar interbody fusion (UITLIF) with bilateral instrumented TLIF (BITLIF) regarding radiological alignment, including the coronal balance, even though UITLIF might have asymmetric characteristics in the coronal plane. This retrospective study aimed to compare the clinical and long-term radiological outcomes of 1-level UITLIF and BITLIF in lumbar degenerative diseases (LDD) including lumbar spinal stenosis with or without spondylolisthesis (degenerative or spondylolytic). Materials and Methods: Patients who underwent 1-level UITLIF with two rectangular polyetheretherketone (PEEK) cages or BITLIF between November 2009 and June 2016 by four surgeons with ≥5 years of follow-up at a single hospital were included. We compared the clinical and radiological outcomes between the UITLIF and BITLIF. Results: In total, 63 and 111 patients who underwent UITLIF and BITLIF, respectively, were enrolled. The median follow-up was 85.55 months (range: 60–130). The UITLIF group had a significantly shorter operation time (185.0 [170.0–210.0] vs. 225.0 [200.0–265.0], p < 0.001) and lower estimated blood loss (300.0 [250.0–500.0] vs. 550.0 [400.0–800.0], p < 0.001) than the BITLIF group. Regarding the clinical outcomes, there were no significant differences in the intermittent claudication score (p = 0.495) and Kirkaldy–Willis criteria (p = 0.707) at 1 year postoperatively. The interval changes in the local coronal Cobb angle at the index level, L1-S1 lordotic angle, and coronal off-balance from the immediate postoperative radiograph to the last follow-up were not significantly different (p = 0.687, p = 0.701, and p = 0.367, respectively). Conclusions: UITLIF with two rectangular PEEK cages may provide comparable clinical outcomes and radiological longevity including coronal alignment to BITLIF in 1-level LDD. In addition, UITLIF has advantages over BITLIF in terms of operative time and blood loss. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated. Results: Sixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores. Conclusions: VP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures. Highlights: Osteoporosis primarily affects the elderly with the fourth leading cause of disability Osteoporotic vertebral compression fractures are commonly encountered, but require special attention given the age and co-morbidities of the patients Minimally invasive spinal surgery should be the first choice of the treatment of osteoporotic vertebral compression fractures Vertebroplasty remains the quickest and safest minimally invasive method in the treatment of compression fractures Vertebroplasty can be safely employed with other minimally invasive approaches, such as TLIF and transpedicular screw system in selected patients [ABSTRACT FROM AUTHOR]

Objective: To comprehensively compare the perioperative data and clinical outcomes of natural pressure drainage (NAPD) and negative pressure drainage (NEPD) following transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degeneration disease. Methods: Between January 2021 and December 2021, 203 patients in our hospital who underwent single- or two-segment TLIF were assigned to the NAPD group (112 patients) or the NEPD group (91 patients) based on different postoperative drainage methods. Between the two groups, comparisons were made regarding the demographics, intraoperative and postoperative data, patient-reported outcomes, and complications. Results: The NAPD group experienced less overall drainage and fewer postoperative drainage days (157.89 vs. 318.49 ml/249.54 vs. 589.43 ml, 2.00 vs. 2.67 days/2.04 vs. 2.74 days, P < 0.001) than the NEPD group. The NAPD group has a higher rate of overall hidden blood loss (HBL) than the NEPD group (63.98% vs. 51.90%/65.80% vs. 48.11%, P < 0.001); HBL, however, did not significantly differ between the two groups (P > 0.05). In two-segment surgery, the postoperative hemoglobin (HGB) levels were higher in the NAPD group (99.67 vs. 92.69 g/L, P < 0.05), but there was no difference in single-segment surgery (P > 0.05). Regardless of whether single- or two-segment surgery was performed, the NAPD group had a lower HGB level loss (18.81% vs. 21.63%/26.35% vs. 32.08%, P < 0.05). There was no discernible difference between the two groups in the visual analog scale (VAS) scores for symptomatic epidural hematoma, postoperative body temperature, low back and leg pain, or incision infection (P > 0.05). Conclusion: NAPD did not increase postoperative complications but did significantly reduce postoperative drainage volume and the risk of anemia. We show that, when compared to NEPD, NAPD may be a better option for patients following TLIF. [ABSTRACT FROM AUTHOR]