Comparison Of Transforminal Lumbar Interbody Fusion (TLIF) With Lateral Lumbar Interbody Fusion(LLIF): Clinical And Radiological Outcomes

Background:The use of lateral approach to lumbar fusion has gradually increased.With increasing development of mini-open lateral approach, it is important to compare LLIF and conventional approaches. There is no conclusive evidence to prove that LLIF is better than other surgical approaches and a variety of clinical research trials required to looking for answers.Objective:The object of our study is to compare the clinical and radiological outcomes of the two methods of lumbar interbody fusion: TLIF, PLIF and LLIF.Method:From June 2014 to February 2016, we reviewed the medical records who underwent LLIF(46 patients) and TLIF(97 patients). The two approaches(TLIF and LLIF) were compared with the operation times,blood losses, incision lengths, incision drainages, VAS, hospitalization times and complications.The preoperative and postoperative disc heights,coronal angles, and foramen areas were measured and compared on radiographs.Result:The pre- and post-operative VAS between the LLIF(6.67±1.37,1.41±0.86) and TLIF(6.24±1.22,1.49±0.81) were not significantly different(P>0.05). TLIF displayed significant advantages over LLIF considering the operative time for 1-level( 109.33±19.46 min and136.86±18.27min)and 2-levels(137.56±22.59 min and 165.91±21.77min)surgery(P<0.05). LLIF displayed significant advantages over TLIF considering the blood loss for 1-level(59.77±18.66 ml and 296.90±77.64ml)and 2-level(92.73±26.96 and 406.41±77.92ml) surgery(P<0.05). The total incision lengths between the LLIF(10.74±1.34 cm for 1-level and13.86±1.23 for 2-levels) and TLIF(11.12±1.36 cm for 1-level and13.14±1.15 for 2-levels) were not significantly different(P>0.05). LLIF displayed significant advantages over TLIF considering the incision drainages of the first day after surgery(89.30±47.14 ml and182.33±64.94ml), hospitalization times(13.30±4.13 days and 14.85±3.79days), and the changes of disc heights(4.55±2.20 mm and 3.33±1.35mm),coronal angles(-4.49±2.26°and-2.73±1.16°) and foramen areas(56.00±14.72mm2 and 32.38±11.90mm2)(P<0.05).Conclusion:In the case of strictly surgical indications, LLIF is effective for indirect decompression. It is not only able to improve neurological function,but also improve the quality of life for treating lumber diseases. LLIF displayed a lower complications rate and less recovery time than TLIF and PLIF.