Transfacet transforaminal lumbar interbody fusion (TF-TLIF) results in greater change in spondylolisthesis and posterior disc height compared to percutaneous TLIF (Perc-TLIF) or minimally invasive TLIF (MIS-TLIF): a retrospective study.

BACKGROUND

The evolution of the transforaminal lumbar interbody fusion (TLIF) has resulted in the popularization of three main techniques: the minimally invasive TLIF (MIS-TLIF), the transfacet TLIF (TF-TLIF), and the percutaneous TLIF (Perc-TLIF). While MIS methods have previously been established as superior to open TLIF, there remains an unclear consensus on the utility and clinical outcomes associated with these different MIS techniques. This study aims to compare clinical and radiographic outcomes between the three approaches to TLIF.

METHODS

A retrospective analysis of the electronic medical records of a single fellowship-trained surgeon was performed for all patients receiving a single-level Perc-TLIF, MIS-TLIF, or TF-TLIF between 2018 and 2024. Variables collected included pre-operative and post-operative radiographic measures (e.g., change in spondylolisthesis, disc height, segmental lordosis), as well as clinical outcomes (e.g., length of stay, operating time, opioid utilization, readmission rates), and data were analyzed using a multivariable regression model.

RESULTS

Ninety-four total patients undergoing TLIF surgery were identified (TF-TLIF: n=17; MIS-TLIF: n=31; Perc-TLIF: n=46). In our regression model accounting for other clinical and radiographic variables, the transfacet approach was associated with greater change in spondylolisthesis (vs. MIS, P=0.03) and posterior disc height (vs. MIS, P=0.005). The percutaneous approach was associated with lower estimated blood loss (vs. MIS, P=0.004).

CONCLUSIONS

Although there are limitations, the TF-TLIF shows promising results compared to MIS-TLIF and Perc-TLIF approaches, with improved spondylolisthesis reduction and posterior disc height correction.