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Clinical and Radiologic Outcomes of TLIF Applications With or Without Pedicle Screw: A Double Center Prospective Pilot Comparative Study

Kotil, Kadir MD*; Ali Akçetin, Mustafa MD; Savaş, Yildiray MD

Journal of Spinal Disorders and Techniques: October 2013 - Volume 26 - Issue 7 - p 359–366
doi: 10.1097/BSD.0b013e318249599f

Study Design: Prospective cohort data by merging data from comparative studies.

Objective: This study aimed to compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease.

Summary of Background Data: The unilateral lumbar interbody fusion technique has gained popularity in the management of many lumbar degenerative conditions requiring fusion. TLIF is routinely performed with the support of pedicle screws. The use of the TLIF procedure without pedicle screw support has not yet been reported.

Methods: Between February 2006 and May 2009, surgical decompression and fusion was performed in patients with lumbar degenerative conditions using the TLIF technique either with (n=30, group A) or without pedicle screw support (n=30, group B). The 2 groups had similar age, sex distribution, pain level, and pain history. In this prospective study, patients were followed for a mean period of 31 months (range, 22 to 38 mo). The mean age was 45.5 years (range, 29 to 78 y), and all patients had a disease involving a single intervertebral space.

Results: The female to male ratio was 19:11 and 18:12 in groups A and B, respectively. Pain and function were evaluated by the Oswestry disability index and visual analog scale. Pseudoarthrosis developed in 2 patients from group A and in 3 patients from group B. Although these 5 patients had insufficient fusion, they did show a clinical improvement. The mean duration of the operation was 110 and 73 minutes in groups A and B, respectively. The mean total amount of bleeding was 410 and 220 mL in groups A and B, respectively. Cage loosening did not occur in group A, but 1 patient in group B developed asymptomatic cage loosening limited to the endplates. Four patients in group A suffered sciatic pain because of the malposition of the screw, and 1 patient in group B had contralateral sciatic pain lasting for 2 months. The visual analog scale and Oswestry disability index scores were higher in group A than in group B 1 month after the operation (P<0.005), but the groups did not significantly differ at 3 months (P<0.89). The cost of the procedure was 3-fold higher in group A compared with group B.

Conclusions: This study showed that the TLIF procedure without pedicle screw support would be sufficient in the management of preoperatively stable patients with lumbar degenerative spinal disease requiring fusion after single-level decompression. This technique is minimally invasive, requires only unilateral intervention, allows magnetic resonance imaging during the postoperative period and is associated with less costs and complications when compared with pedicle screwing. This study represents the first prospective comparative report on this technique showing several of its advantages.

*Department of Neurosurgery, Istanbul Educational and Research Hospital

Department of Neurosurgery

Department of Radiology, Haseki Educational and Research Hospital, Istanbul, Turkey

The authors declare no conflict of interest.

Reprints: Kadir Kotil, MD, Hasan Ali yücel. Sok. Senil apt. 34-14 çiftehavuzlar-Kadikoy, 34728 Istanbul, Turkey (e-mails:;

Received May 7, 2011

Accepted December 8, 2011

© 2013 by Lippincott Williams & Wilkins, Inc.