Outcomes of Revision vs. Primary Transforaminal Interbody Fusion in 328 Patients

2011

SUMMARY

Outcomes of TLIF as a revision (n=126) vs primary (n=202) procedure were compared. Despite worse ODI and VAS scores, revision patients had similar improvement in outcome scores and complication rates

INTRODUCTION

Transforaminal lumbar interbody fusions (TLIFs) have reliable rates of fusion and well-documented complications. However, the clinical benefit TLIFs offer patients in revision surgery, which often yields worse outcomes with higher complication rates, is uncertain.

METHODS

328 consecutive patients at one center underwent TLIF at 564 levels as a primary procedure (n= 202) or as a revision (n= 126). Diagnoses were spondylolisthesis (n= 110), scoliosis (n= 73), and other degenerative spinal disorders (n= 145). Clinical outcomes were obtained prospectively by visual-analog pain scale (VAS) and Oswestry Disability Index (ODI) at pre-op, 1 year, 2 year, and latest follow-up.

RESULTS

Revision patients had significantly worse clinical scores compared with primary patients at all time intervals, for both VAS (pre-op: 6.7 vs 6.0, p=0.040; 1 yr: 3.5 vs 2.5, p=0.001; 2 yr: 3.6 vs 2.8, p=0.010) and ODI (pre-op: 53.9 vs 45.5, p<0.001; 1 yr: 32.7 vs 21.5, p<0.001; 2 yr: 36.5 vs 25.2, p=0.011). However, clinical improvement at 2 years was significant and similar between the groups for both VAS (2.9 vs 3.0, p=0.607) and ODI (17.3 vs 18.0, p=0.233). Complications between revision and primary groups were similar and included non-union (1[0.8%] vs 5[2.5%]), adjacent level fracture (11[8.7%] vs 8[4.0%]), infection (2[1.6%] vs 4[2.0%]), foot drop (2[1.6%] vs 2[1.0%]), implant failure (1[0.8%] vs 1[0.5%]), seroma (1[0.8%] vs 1[0.5%]), symptomatic implant (3[2.4%] vs 4[2.0%]), spinal imbalance (2[1.6%] vs 6[3.0%]), arachnoiditis (2[1.6%] vs 2[1.0%]), ileus (0[0.0%] vs 1[0.5%]), and revision for junctional kyphosis (5[4.0%] vs 14[6.9%]). There were no cases of PE, stroke, or MI in either group.

CONCLUSIONS

Posterior spinal fusion (PSF) with TLIF produces significant clinical improvement at 2 years. Despite having worse initial ODI and VAS scores, revision patients benefit from TLIF procedures as much as patients undergoing primary surgeries, with similar complication rates.

SIGNIFICANCE

TLIF procedures produce significant functional improvement in patients at 2 years post-op, even in revision scenarios.