A comprehensive study on the unilateral transforaminal technique for lumbar interbody fusion

The unilateral Transforaminal technique for Lumbar Interbody Fusion (TLIF) is emerging as a promising alternative to Anterior Lumbar Interbody Fusion (ALIF) and Posterior Lumbar Interbody Fusion (PLIF) with pedicle screw instrumentation. This study aimed to evaluate the long-term outcomes of TLIF, involving 52 patients with a minimum follow-up of three years and an average follow-up of 46 months. Indications included isthmic spondylolisthesis (22 cases) and lumbar spine degenerative diseases (30 cases), with 39 one-level, 11 two-level, and 2 three-level fusions. Pain and disability were assessed using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), and bone fusion was evaluated via radiographs. One-level fusions averaged 173 minutes, while multiple-level fusions averaged 238 minutes, with mean blood losses of 485 mL and 560 mL, respectively. Significant complications included deep infection, prolonged radiculopathy, contralateral disc herniation, and pseudarthrosis. Despite these issues, VAS and ODI improvements were statistically significant (P=0.05), and the fusion rate was 89%. The TLIF approach demonstrated outcomes comparable to PLIF and ALIF, with benefits of avoiding the anterior approach and minimizing posterior spinal canal damage. The study concludes that TLIF is an effective technique for lumbar interbody fusion, offering substantial pain relief and functional improvement over a significant follow-up period.