Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Orthopedic Surgery, Washington University Hospital, St. Louis, MO.
Spine (Phila Pa 1976). 2024 Aug 1;49(15):1078-1084. doi: 10.1097/BRS.0000000000004833. Epub 2023 Sep 22.
Retrospective cohort study.
To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs).
TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared the two, none have considered TLIFs with anteriorly placed cages, which may serve as a better comparison to ALIFs.
Patients undergoing TLIF or ALIF with posterior instrumentation from 2010 to 2020 at a tertiary care institution were retrospectively identified. TLIF cage position was assessed and those with anterior placement were included. Electronic medical records were reviewed to identify patient characteristics and patient-reported outcomes. Radiographic outcomes included posterior disc height (DH), lumbar lordosis (LL), sacral slope, pelvic incidence, and pelvic tilt. Statistical analysis was performed to compare the two groups.
Of the 351 patients, 108 had ALIF with posterior instrumentation and 207 had a TLIF. Preoperatively, patients undergoing TLIF had less LL (53.7° vs . 60.6°, P < 0.001), sacral slope (38.3° vs . 43.7°, P < 0.001), and pelvic incidence (60.1° vs . 66.1°, P < 0.001), all of which remained significant at 1-year and long-term follow-up ( P < 0.001). The TLIF group had less ∆DH (1.51° vs . 5.43°, P < 0.001), ∆LL (1.8° vs . 2.97°, P = 0.038), and ∆segmental lordosis (0.18° vs . 4.40°, P < 0.001) at 1 year postoperatively. At 2 to 3 years, ∆DH ( P < 0.001) and ∆segmental lordosis ( P = 0.001) remained significant, but ∆LL ( P = 0.695) did not. Patients in the TLIF group had higher Visual Analog Scale-Back scores 1 year postoperatively (3.68 vs . 2.16, P = 0.008) and experienced less improvement in Oswestry Disability Index (-17.1 vs . -28.6, P = 0.012) and Visual Analog Scale-Back (-2.67 vs . -4.50, P = 0.008) compared with patients undergoing ALIF.
Our findings suggest that ALIF with posterior instrumentation performed superiorly in radiographic outcomes and patient-reported outcomes compared with anteriorly placed TLIFs. Anteriorly placed TLIF cages may not achieve the same results as those of ALIF cages.
回顾性队列研究。
比较经前路椎间孔腰椎体间融合术（TLIF）和前路腰椎体间融合术（ALIF）的结果。
TLIF 和 ALIF 是近年来越来越流行的手术技术。尽管已经有研究比较了这两种技术，但没有一项研究考虑过前路放置的椎间融合器，因为这可能与 ALIF 更好地进行比较。
回顾性地确定了 2010 年至 2020 年在一家三级医疗机构接受 TLIF 或 ALIF 联合后路器械固定的患者。评估 TLIF 椎间融合器的位置，并纳入前路放置的患者。查阅电子病历以确定患者特征和患者报告的结果。影像学结果包括后路椎间盘高度（DH）、腰椎前凸（LL）、骶骨倾斜度、骨盆入射角和骨盆倾斜度。进行统计分析以比较两组。
在 351 例患者中，108 例接受 ALIF 联合后路器械固定，207 例接受 TLIF。TLIF 组患者术前 LL（53.7° vs. 60.6°，P < 0.001）、骶骨倾斜度（38.3° vs. 43.7°，P < 0.001）和骨盆入射角（60.1° vs. 66.1°，P < 0.001）较小，这些结果在 1 年和长期随访时仍然显著（P < 0.001）。TLIF 组术后 1 年 DH 差值（1.51° vs. 5.43°，P < 0.001）、LL 差值（1.8° vs. 2.97°，P = 0.038）和节段性前凸差值（0.18° vs. 4.40°，P < 0.001）较小。术后 2 至 3 年，DH 差值（P < 0.001）和节段性前凸差值（P = 0.001）仍有显著差异，但 LL 差值（P = 0.695）无显著差异。TLIF 组患者术后 1 年视觉模拟量表-背部评分较高（3.68 vs. 2.16，P = 0.008），Oswestry 残疾指数（-17.1 vs. -28.6，P = 0.012）和视觉模拟量表-背部评分（-2.67 vs. -4.50，P = 0.008）改善程度较低。
我们的研究结果表明，与前路放置的 TLIF 相比，后路器械固定的 ALIF 在影像学结果和患者报告的结果方面表现更好。前路放置的 TLIF 椎间融合器可能无法达到与 ALIF 椎间融合器相同的效果。
