Addition of TLIF does not improve outcome over standard posterior instrumented fusion. 5–10 years long-term Follow-up: results from a RCT

• Published in: European spine journal Vol. 26; no. 3; pp. 658 - 665
• Main Authors: Høy, Kristian, Truong, Kamilla, Andersen, Thomas, Bünger, Cody
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2017; Springer Nature B.V
• Subjects: Adult; Aged; Disability Evaluation; Female; Follow-Up Studies; Humans; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Pain Measurement; Patient Satisfaction; Prospective Studies; Spinal Fusion - methods; Surgical Orthopedics; Transforaminal lumbar inter-body fusion (TLIF); Randomized clinical trial (RCT); Long-term; Posterolateral instrumented lumbar fusion (PLF); Functional outcome
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-016-4592-3

Purpose
The use of inter-body device in lumbar fusions has been difficult to validate, only few long-term RCT are available.
Methods
Between 2003 and 2005, 100 patients entered a RCT between transforaminal lumbar inter-body fusion (TLIF) or posterolateral instrumented lumbar fusion (PLF). The patients suffered from LBP due to segmental instability, disc degeneration, former disc herniation, spondylolisthesis Meyerding grade <2. Functional outcome parameters as Dallas pain questionnaire (DPQ), SF-36, low back pain questionnaire (LBRS), Oswestry disability index (ODI) were registered prospectively, and after 5–10 years.
Results
Follow-up reached 93 % of available, (94 %, 44 in the PLF’s and 92 %, 44 in the TLIF group
p
 = 0.76). Mean follow-up was 8.6 years (5–10 years). Mean age at follow-up was 59 years (34–76 years
p
 = 0.19). Reoperation rate in a long-term perspective was equal among groups 14 %, each
p
 = 0.24. Back pain was 3.8 (mean) (Scale 0–10), TLIF (3.65) PLF (3.97)
p
 = 0.62, leg pain 2.68 (mean) (Scale 0–10) 2.90 (TLIF) and 2.48 (PLF)
p
 = 0.34. No difference in functional outcome between groups
p
 = 0.93. Overall, global satisfaction with the primary intervention at 8.6 year was 76 % (75 % TLIF and 77 % PLF)
p
 = 0.85.
Conclusion
In a long-term perspective, patients with TLIF’s did not experience better outcome scores.