Journal List > J Korean Soc Spine Surg > v.15(2) > 1035836

Kim, Jeon, Ryu, Kim, and Hwang: Unilateral Transforaminal Lumbar Interbody Fusion in Spondylolisthesis - Comparison with Conventional Posterior Lumbar Interbody Fusion Through Bilateral Approach -


Study Design

Retrospective controlled study.


The aim of this study was to determine if unilateral TLIF is comparable to conventional PLIF with regard to radiologic and clinical outcomes, and to examine the viability of local bone for bone grafting in lumbar interbody fusion.

Summary of Literature Review

TLIF, a modified form of PLIF, is a new spinal fusion technique that avoids the typical complications of PLIF.

Materials and Methods

We analyzed 32 cases of single-level TLIF or PLIF in patients with degenerative or isthmic spondylolisthesis, who were followed for more than 1 year. The patients in group 1 underwent TLIF, and the patients in group 2 underwent PLIF. The fusion rate, changes in disc height, and degree of anterolisthesis in the fused segment were analyzed radiologically. The clinical results were evaluated using the Oswestry Disability Index and visual analog scale. We also analyzed operative time, blood loss, and complications in both groups.


Radiologically and clinically, there were no significant differences between the two groups in terms of fusion rate, changes in disc height, or degree of anterolisthesis in the fused segment. The mean operative time was 200 minutes in group 1 and 240 minutes in group 2. The mean blood loss was 854 ml in group 1 and 1102 ml in group 2(p®0.05).


TLIF is a potentially useful alternative to conventional PLIF in patients with degenerative or isthmic spondylolisthesis. Additionally, local bone may be a viable source of bone grafts for single-level TLIF and PLIF.


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Fig. 1.
Various instruments are utilized to thoroughly clean the disc and cartilaginous endplate from the disc space. Special angled curets are helpful in reaching the contralateral protions of the disc.
Fig. 2.
A Structural interbody implant is placed into the disc space to support the loads of the spine and promote fusion. In this figure, an oblique implant is shown.
Fig. 3.
Postoperative radiological studies obtained in a 59 year old woman after one level fusion for spondylolithesis. (A) Preoperative lateral radiograph show narrowing of L4-5 disc space and anterior translation of L4 body. (B) Postoperative lateral radiograph shows restoration of the intervertebral disc height and reduction of anterolisthesis. (C) Lateral radiography obtained 12 months postoperatively. Note that the intervertebral height and reduction of anterolisthesis is well preserved. Note also that the bone density the entire disc space is well preserved, indicating probable progression toward solid arthrodesis. (D) Sagittal reconstructed CT scan obtained at 7 months postoperatively, demonstrating excellent interbody fusion with bone columns.
Table 1.
Patient Data
  Group I Group II
Number 14 18
(Degenerative /Isthmic) (6/8) (7/11)
Age (years) 53.6(33~72) 65.8(49~79)
Sex (M:F) 4:10 6:12
Fusion segment    
L3-4 12 12
L4-5 19 12
L5-S1 13 14 1
Meyerding Grade I 10 12
II 14 16
Follow-up (months) 18(12~30) 20(12~40)
Table 2.
Radiological Results
  Group I Group II
Fusion rate 92.9% 100%
Intervertebral height    
Preoperative 19.9±2.1 mm 19.7±4.4 mm
Postoperative 13.5±3.5 mm .113±3.9 mm
Last follow-up 13.4±3.4 mm 12.7±3.6 mm
Preoperative 15.1(8~27)% 17.1(6~33)%
Postoperative 17.2(0~13)% 17.1(0~17)%
Last follow-up 17.8(0~13)% 17.5(0~17)%
Table 3.
Clinical Results
  Group I Group II
Preoperative 28.4 22
Last follow-up 9.5 8.0
VAS (back pain/leg pain)    
Preoperative 5.2/7.1 4.6/7.6
Last follow-up 3/2.8 2.9/1.7
Operation time (minutes) 200 240
Blood loss (ml) 854 1102
Implant failure 1 -
Neuralgia - 2

ODI : Oswestry Disability Index

VAS : Visual analog scale

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