A study recently published in The Journal of Spinal Disorders and Techniques compares the benefits of transforaminal lumbar interbody fusion and posterolateral spine fusion over two years.
Researchers examined patients with degenerative spondylolisthesis with disc pathology and/or postdecompression instability. The patients underwent two-level TLIF and were examined for two years. Those patients were matched to a cohort of PSF patients based on various traits to measure effectiveness.
Roger Kirk Owens, MD, Leah Y. Carreon, MD, MSc, Mladen Djurasovic, MD, and Steven D. Glassman, MD, authored the article.
Here are five key findings from the study:
1. All patients in both groups reported statistically significant improvement in health-related quality of life after two years compared with the baseline. A 2011 study published in the Journal of Neurosurgery: Spine shows TLIF is cost-effective for patients with spondylolisthesis-associated back and leg pain. The total cost per QALY gained for TLIF was $42,854 when evaluated two years after surgery.
2. Oswestry disability index, SF-36 physical component summary score and back and leg pain scores within the spondylolisthesis and disc pathology subgroups were similar between the TLIF and PSF group. Another 2012 study examined the cost per quality-adjusted life year among patients undergoing single-level posterolateral lumbar fusion and found total cost per QALY gained was around $53,000 at five years postoperatively.
3. TLIF outperformed PSF for every outcome measure in the postdecompression instability subgroup. An International Scholarly Research Notices Minimally Invasive Surgery article examined two-level MIS TLIF with a single incision followed by bilateral percutaneous pedicle screw insertion and found it a feasible and safe technique.
4. An earlier study published in the Journal of Spinal Disorders & Techniques shows minimally invasive TLIF has shorter hospital length of stay, reduced postoperative narcotic use and quicker return to work than the open procedure. The MIS patients left the hospital in three days — compared to four to six days in the open group — and were able to return to work in 8.5 weeks — compared to 17.1 weeks for the open group.
5. Several device companies have recently launched or introduced new TLIF technology, including:
• 3D Expandable Intervertebral TLIF Cage from Expanding Orthopedics
• AnyPlus T/PLIF Cage from GS Medical USA
• Tezo TLIF from ulrich medical
Additionally, the InFill 41-TLIF Convex Oblique Device from Pinnacle Spine received FDA 510(k) clearance in March 2014.
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