ABSTRACT

Object:

Transforaminal lumbar interbody fusion (TLIF) is widely used with pedicular screw fixation. In this comparative randomized study, we aimed to search effect of the instrumentation to clinical results of patient with TLIF.

Methods:

60 patients with lumbar degenerative diseases underwent single level TLIF with or without posterior segmental pedicle screw fixation. The Oswestry disability index (ODI) and Visual Analogue Scale (VAS) was used before surgery to the latest evaluation. Fusion was investigated both coronal and sagittal computerized tomography (CT) images.

Results:

All patients were evaluated after a mean follow-up of 44 +/- 12 months. ODI and VAS scores were both better in Group C, (p < 0.05). Group A patients showed significant changes in back pain (p < 0.05). There was no difference in any score between groups after the 1 year (p > 0.05). The mean preoperative scores of VAS for low back pain for Groups A, B, and C were 6, 6.5, and 5.8, respectively, and decreased after the early surgery to 1.8, 1.5, and 0.6, respectively. The mean preoperative scores of the VAS for leg pain for Groups A, B, and C were 7.1, 7.6, and 6.9, respectively, and decreased after surgery to 2.1, 2.5, and 2.3, respectively. Group C was the cost effective group (p < 0.005). No patient required revision surgery for instrumentation failure and cage displacement in all groups. Delayed hardware failure without asymptomatic 14 months after surgery radiologic pseudarthrosis was observed in 1(5 %) patients in GroupA, in 1(5 %) patient B, and in 2 (10 %)patient in C. There was no adjacent segment degeneration in any spine until the last evaluation.

Conclusion:

TLIF alone, when compared with TLIF with adjunctive bilateral or unilateral pedicular fixation is a sufficient amount for the fusion and cost effective treatment in lumbar degenerative diseases as a new treatment technique.