title: Relative benefit of TLIF versus PSF stratified by diagnostic indication.
abstract: METHODS
  Case-matched retrospective.
  
  
  OBJECTIVE
  The purpose of this study is to compare 2-year health-related quality of life (HRQOL) outcomes of patients who underwent 1-level or 2-level posterolateral spine fusion (PSF) versus transforaminal interbody fusion (TLIF) for degenerative spondylolisthesis, disk pathology, and postdecompression instability.
  
  
  BACKGROUND
  The optimal surgical technique for patients with spondylolisthesis or other degenerative conditions has not been defined. Historically, PSF was the most common procedure, whereas in recent years TLIF has gained popularity. Although theoretical advantages for TLIF have been outlined, evidence for improved outcomes with the addition of interbody support is limited.
  
  
  METHODS
  Patients with degenerative spondylolisthesis, with disk pathology and or postdecompression instability who underwent 1-level or 2-level TLIF and completed 2 years postoperative HRQOL measures were identified from a prospective database. These patients were then propensity-matched to a cohort of PSF patients based on age, number of surgical levels, body mass index, sex, smoking status, workers' compensation status, and preoperative outcome measures including the Oswestry Disability Index, SF-36 Physical Component Summary score, SF-36 Mental Composite Summary score, and back and leg pain scores. This produced 63 matched pairs with degenerative spondylolisthesis, 46 with disk pathology and 32 with postdecompression instability.
  
  
  RESULTS
  All patients in both groups for each cohort reported statistically significant improvement in HRQOL scores at 2 years postoperatively compared with baseline. Improvements in the Oswestry Disability Index, SF-36 Physical Component Summary score, and back and leg pain scores within the spondylolisthesis and disk pathology subgroups were similar between patients who had a TLIF compared with those who had a PSF. The postdecompression instability subgroup was the only subgroup in which TLIF outperformed PSF for every outcome measure.
  
  
  CONCLUSIONS
  Clinical outcome was not significantly altered with TLIF as compared with PSF in patients with spondylolisthesis or disk pathology. However, TLIF resulted in better outcomes at 2 years postoperatively in patients with postdecompression instability.
authors.affiliation: Norton Leatherman Spine Center, Louisville, KY.
authors.forename: Roger Kirk
authors.initials: RK
authors.lastname: Owens
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
authors.forename: Mladen
authors.initials: M
authors.lastname: Djurasovic
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013122:Spinal Diseases / Q000175:diagnosis* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome