Comparison of clinical efficacy of modified transforaminal lumbar interbody fusion (M-TLIF) and posterior lumbar interbody fusion (PLIF) with bone cement-reinforced pedicle screws for osteoporosis combined with lumbar degenerative disease.

OBJECTIVE

To compare modified transforaminal lumbar interbody fusion (M-TLIF) and posterior lumbar interbody fusion (PLIF) in patients with lumbar degenerative disease complicated by osteoporosis who underwent bone cement-augmented pedicle screw placement, with a focus on lumbar radiographic parameters and clinical outcomes.

METHODS

A retrospective comparative study was conducted on patients with lumbar degenerative disease and osteoporosis who underwent lumbar fusion surgery with bone cement-augmented pedicle screws between January 2021 and June 2023. Based on the surgical procedure received, patients were divided into an M-TLIF group (n = 49) and a PLIF group (n = 44). The comparison encompassed perioperative indicators, radiographic parameters-including the coronal Cobb angle, average surgical segment disc height (ASDH), lumbar lordosis (LL), segmental lordosis (SL), Bridwell fusion grade, and Marchi subsidence grade-and clinical efficacy scores, including the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score, which were assessed preoperatively, immediately postoperatively, and at 2-year postoperatively.

RESULTS

The study included 93 patients (M-TLIF: n = 49; PLIF: n = 44). The two groups were comparable in all baseline characteristics (P > 0.05). Regarding perioperative indicators, the M-TLIF group had a significantly longer operative time per segment (185.79 ± 78.46 min vs. 152.92 ± 71.64 min, P = 0.038) but a lower volume of bone cement used per screw (1.86 ± 0.58 ml vs. 2.15 ± 0.62 ml, P = 0.023). Both groups demonstrated significant improvements in all clinical scores (VAS, ODI, JOA) and radiographic parameters (Cobb, ASDH, LL, SL) at all postoperative time points compared to preoperative values (all P < 0.05). At the 2-year postoperatively, VAS and ODI scores were comparable between groups (P > 0.05). Although the JOA score was statistically higher in the PLIF group (25.73 ± 1.26 vs. 25.12 ± 1.51, P = 0.040), the absolute difference of 0.61 points is clinically negligible. Radiographically, the PLIF group achieved a significantly greater SL angle at follow-up (16.59 ± 8.59° vs. 12.17 ± 8.16°, P = 0.013), while the M-TLIF group showed a significantly superior Bridwell fusion grade (P = 0.020). There was no significant intergroup difference in cage subsidence (P > 0.05).

CONCLUSION

Both M-TLIF and PLIF effectively improved the clinical symptoms and radiographic parameters of these patients, with equivalent clinical efficacy in relieving pain and restoring function. The choice of procedure can be individualized: M-TLIF is preferred when superior interbody fusion is the priority, while PLIF is more suitable for achieving greater segmental lordosis.