Lumbar Lateral Interbody Fusion (LLIF) vs. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results

Presented at SMISS Annual Forum 2014
By Joseph M. Zavatsky MD
With David C. Briski MD, Richard Frisch MD,

Disclosures: Joseph Zavatsky MD B; Amendia, Biomet, Depuy, Stryker. D; Innovative Surgical Solutions, Safe Wire, Vivex. F; Biomet. David Briski MD None, Richard Frisch MD B; Globus,

Introduction:
The benefits of Minimally Invasive Surgery (MIS) continue to be elucidated. These include decreased soft tissue disruption, blood loss, and shorter length of stay (LOS). The benefits of one MIS procedure over the other (LLIF vs TLIF) have yet to be clinically established. We analyzed the operative time and blood loss, post-operative VAS scores, and LOS associated with each procedure.

Aims/Objectives:
To evaluate and compare patient centered results and benefits of LLIF and TLIF interbody fusion techniques in the treatment of similar patient pathology.

Methods:
A retrospective multi-centered review was performed from 2008 to 2014. All patients with one and two-level MIS TLIF and LLIF procedures were included. Total operative time, blood loss, immediate post-op and day of discharge VAS pain scores, along with LOS were recorded. Patients were divided into 2 groups. Group 1 had LLIF procedures; Group 2 had TLIF procedures.

Results:
A total of 92 patients were included. Group 1 included 52 patients. Group 2 included 40 patients. There was no difference in BMI, number of levels fused, peri-operative complications, or immediate post-op and discharge VAS scores between the 2 groups. A statistically significant benefit was observed in the LLIF vs TLIF group when assessing the mean operative time in minutes (154 vs 265, P<0.001), total operative blood loss (102 vs 206 ml, P<0.001), number of patients discharged on Post-Op Day (POD) #1 (48% vs 0%, P<0.001), and overall LOS (2.1 vs 3.5 days, P<0.001). The mean LOS reduction was statistically strengthened when the patient cohort was further stratified to include only one-level fusions [Group 1: 37 patients; Group 2: 21, (1.6 vs 3.4 days, P<0.0001)].

Conclusions:
The benefits of MIS surgery continue to be validated and include decreased soft tissue disruption, blood loss, and shorter hospital LOS. We found no difference in peri-operative complications or immediate post-op or discharge VAS scores between the 2 groups. Forty-eight percent of LLIF patients (0% in TLIF group) were discharged on POD 1, which contributed to the significant reduction in overall LOS in the LLIF group (2.1 vs 3.5 days, P<0.001). Further stratification and analysis of the cohort to include only one-level fusions resulted in a greater difference in overall LOS (1.6 vs 3.4 days, P<0.0001). Total operative time and blood loss was also significantly lower amongst the LLIF group. Further prospective analysis is required to evaluate the financial implications and comprehensive benefit of one procedure over the other.