Comparative Analysis of Transforaminal Interbody Fusion and Posterior Lumbar Interbody Fusion in Degenerative Spinal Disease

Fatima Akram; Sundus Ali; Basit Ali Khan

doi:10.54112/bcsrj.v6i5.2261

Authors

Fatima Akram Department of Neurosurgery, Rawalpindi Teaching Hospital Rawalpindi, Pakistan
Sundus Ali Department of Neurosurgery, Rawalpindi Teaching Hospital Rawalpindi, Pakistan
Basit Ali Khan Department of Neurosurgery, Rawalpindi Teaching Hospital Rawalpindi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.2261

Keywords:

Degenerative lumbar disease, TLIF, PLIF, lumbar fusion, functional outcome

Abstract

Lumbar degenerative spinal diseases are a leading source of disability in all parts of the world and often necessitate surgical stabilization in cases where efforts to manage the same have failed. The most common ones include transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), but comparative evidence in low- and middle-income countries is limited. Objective: To identify the comparable perioperative outcomes, functional recovery, radiographic fusion, and complication rates between TLIF and PLIF in patients undergoing surgery for degenerative lumbar spine disease. Methods: It is a comparative observational study conducted at the Rawalpindi Teaching Hospital in Pakistan from 8 may 2024 to 8 April 2025. Sixty adult degenerative lumbar pathology patients who had to undergo a single- or two-level interbody fusion were selected and randomly assigned to TLIF (n = 30), or PLIF (n=30), either according to surgeon choice or shared decision. Demographics, comorbidities, operative variables and patient-reported outcomes, such as the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain, were recorded. The patients were followed up for 12 months. The outcomes included the duration of surgery, blood loss, hospital stay, fusion rates, complications, and functional recovery. The comparative and multivariate analyses were performed at the p = 0.05 level. Results: There were no significant differences in baseline demographic and clinical characteristics. TLIF was linked to much less intraoperative blood loss (median 300 mL vs. 420 mL, p< 0.001) and reduced hospital stay (median 3 vs. 4 days, p= 0.015). The 12-month radiographic fusion rate was even (93.3%TLIF vs. 90.0%PLIF;p = 0.64). The two groups showed similar, significant results in ODI and VAS scores at 12 months (p > 0.05). There were no significant differences in early and late complication rates. TLIF patients were able to walk independently earlier and go back to work sooner than PLIF patients. PLIF on adjusted analysis was not associated with functional or radiographic outcomes, but was nonetheless independently associated with greater blood loss and a longer hospital stay. Conclusion: TLIF and PLIF are both reasonable surgical procedures for degenerative lumbar spinal disease, and they give similar fusion rates, pain relief, and functional outcomes. TLIF is associated with benefits, including reduced blood loss, a short hospital stay and a quick postoperative recovery. These results endorse TLIF as a patient-focused and cost-effective tool, especially in healthcare settings with limited resources.

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