Research ArticleLumbar Spine

Which Approach Leads to More Reoperations in Single-Level, Open, Posterior Lumbar Fusion: Transforaminal Lumbar Interbody Fusion or Posterolateral Fusion Alone?

Alan R. Tang, Hani Chanbour, Anthony M. Steinle, Soren Jonzzon, Steven G. Roth, Amir M. Abtahi, Byron F. Stephens and Scott L. Zuckerman
International Journal of Spine Surgery February 2023, 8424; DOI: https://doi.org/10.14444/8424

Article Figures & Data

Figures

  • Figure
    Figure

    Comparison of primary and secondary outcomes between transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) cohorts with regard to reoperation rates (A), 90-d complication rate (B), and 90-d readmission rate (C).

Tables

  • Table 1

    Demographic characteristics of patients who underwent TLIF vs PLF.

    VariablesTLIF (N = 591)PLF (N = 259) P Value
    Age, y, mean ± SD59.0 ± 11.363.3 ± 12.6 <0.001a
    Gender (men), n (%)258 (43.7)119 (46.1)0.518
    Race (White), n (%)523 (88.5)230 (88.8)0.263
    BMI, mean ± SD31.3 ± 6.630.2 ± 12.6 0.019a
    Comorbidities, n (%)
     0114 (19.3)41 (15.8)0.472
     1–2365 (61.7)165 (63.7)
     >2112 (20.0)53 (20.5)
     Hypertension352 (59.6)166 (64.1)0.213
     Diabetes mellitus115 (19.5)54 (20.8)0.640
     CAD85 (14.4)38 (14.8)0.912
     CHF12 (2.0)4 (1.5)0.631
     COPD18 (3.0)12 (4.6)0.248
     Osteoporosis11 (1.9)8 (3.1)0.265
    Active smoker, n (%)92 (15.6)28 (10.8)0.071
    Insurance, n (%)a 0.001a
     Private297 (50.3)101 (39.0)
     Public231 (39.1)140 (54.1)
     Military59 (10.0)18 (7.3)
     Uninsured3 (0.5)0 (0.0)
    Currently employed, n (%)271 (45.9)87 (33.6) 0.001a
    Return to work, n (%)219 (80.8)70 (80.4)0.645
    Preoperative ambulation, n (%)0.530
     Independent433 (73.3)181 (69.9)
     With assistance153 (25.9)77 (29.7)
     Wheelchair-bound2 (0.3)1 (0.4)
    Duration of symptoms, n (%)a 0.684
     <3 mo29 (6.0)9 (4.6)
     3–12 mo127 (26.3)49 (25.0)
     >12 mo326 (67.6)138 (70.4)
    Diagnosis, n (%)0.199
     Stenosis119 (20.1)48 (18.5)
     Pseudarthrosis3 (0.5)0 (0.0)
     Spondylolisthesis413 (69.9)185 (71.4)
     Other56 (9.4)26 (10.0)

    • Abbreviations: BMI, body mass index; CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; PLF, posterolateral fusion; TLIF, transforaminal lumbar interbody fusion.

    • ↵a Missing values.

  • Table 2

    Radiographic, perioperative, and postoperative variables of patients undergoing TLIF vs PLF.

    VariablesTLIF (N = 591)PLF (N = 259)P Value
    Radiographic
     Disc height, mm, mean ± SD8.8 ± 3.28.8 ± 2.90.785
     Flexion-extension difference, n (%)68 (11.5)27 (10.4)0.555
     Flexion-extension measurement, mm, mean ± SD3.0 ± 2.62.7 ± 1.50.620
     Spondylolisthesis, n (%)413 (69.9)185 (71.4)0.341
      Grade 1373173
      Grade 23911
      Grade 311
    Perioperative
     Estimated blood loss, cc, mean ± SD415.6 ± 300.8381.7 ± 299.60.190
     Operative time, min, mean ± SD207.4 ± 58.7203.6 ± 55.70.441
    Postoperative
     Length of stay, d, mean ± SD2.8 ± 2.33.0 ± 1.40.110
     Discharged, n (%)a 0.026
      Home510 (86.3)209 (80.7)
      Inpatient rehabilitation facility29 (4.9)26 (10.0)
      Skilled nursing facility14 (2.4)11 (4.2)

    • Abbreviations: PLF, posterolateral fusion; TLIF, transforaminal lumbar interbody fusion.

    • ↵a 38 and 13 missing values in TLIF and PLF, respectively.

  • Table 3

    Outcome variables of patients undergoing TLIF vs PLF.

    VariablesTLIF (N = 591)PLF (N = 259) P Value
    Reoperation, n (%)   
     All reoperations (all F/U)73 (12.4)36 (13.9)0.534
     Reoperation (F/U ≤5 y)24 (10.4)9 (10.6)0.959
     Reoperation (F/U >5 y)49 (13.6)27 (15.5)0.555
    Complication (90 d), n (%)44 (7.4)16 (6.2)0.507
     Urinary tract infection14 (2.4)8 (3.1) 
     Hematoma1 (0.2)1 (0.4) 
     Neurological deficit5 (0.8)1 (0.4) 
     Myocardial infarction3 (15.4)0 (0) 
     Pneumonia4 (0.8)2 (0.8) 
     Deep vein thrombosis2 (0.7)0 (0) 
     Pulmonary embolism1 (0.2)0 (0) 
     Surgical site infection14 (2.4)4 (1.5) 
    Readmission (90 d), n (%)42 (7.1)20 (7.7)0.751

    • Abbreviations: F/U, follow-up; PLF, posterolateral fusion; TLIF, transforaminal lumbar interbody fusion.

  • Table 4

    Univariate and multivariate logistic regression of complications, readmission, and reoperation and presence of interbody fusion.

    VariablesUnivariateMultivariate
    Outcome VariableIndependent VariableOR (95% CI) P ValueOR (95% CI) P Value
    Reoperation
     All reoperations (all F/U)TLIF1.14 (0.74, 1.75)0.5352.26 (0.66, 7.74)0.194
     Reoperation (F/U for ≤5 y)TLIF1.02 (0.45, 2.29)0.9591.27 (0.49, 3.30)0.613
     Reoperation (F/U for >5 y)TLIF1.16 (0.70, 1.94)0.5552.62 (0.65, 10.62)0.177
    Complications (90 d)TLIF1.22 (0.67, 2.20)0.5071.39 (0.19, 9.88)0.742
    Readmission (90 d)TLIF0.91 (0.52, 1.59)0.7511.03 (0.13, 7.72)0.976

    • Abbreviations: F/U, follow-up; TLIF, transforaminal lumbar interbody fusion.

    • Note: Covariates: age, body mass index, flexion-extension difference, flexion-extension difference distance, disc height, spondylolisthesis grade, and spondylolisthesis.

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Which Approach Leads to More Reoperations in Single-Level, Open, Posterior Lumbar Fusion: Transforaminal Lumbar Interbody Fusion or Posterolateral Fusion Alone?
Alan R. Tang, Hani Chanbour, Anthony M. Steinle, Soren Jonzzon, Steven G. Roth, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman
International Journal of Spine Surgery Feb 2023, 8424; DOI: 10.14444/8424
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