title: Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up.
abstract: OBJECTIVE
  The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation.
  
  
  METHODS
  Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery.
  
  
  RESULTS
  The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p < 0.001). No statistic difference in fusion rates was detected.
  
  
  CONCLUSIONS
  Transforaminal interbody fusion did not improve functional outcome in patients compared to posterolateral fusion. Both groups improved significantly in all categories compared to preoperatively. Operation time and blood loss were significantly higher in the TLIF group.
authors.affiliation: Spine Section, Departments of Orthopedics E, Aarhus University Hospital, Aarhus University, Nørrebrogade 44, Aarhus C, 8000, Denmark, wintherhoey@dadlnet.dk.
authors.forename: Kristian
authors.initials: K
authors.lastname: Høy
authors.forename: Cody
authors.initials: C
authors.lastname: Bünger
authors.forename: Bent
authors.initials: B
authors.lastname: Niederman
authors.forename: Peter
authors.initials: P
authors.lastname: Helmig
authors.forename: Ebbe Stender
authors.initials: ES
authors.lastname: Hansen
authors.forename: Haisheng
authors.initials: H
authors.lastname: Li
authors.forename: Thomas
authors.initials: T
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome