Objective : To compare the outcomes of anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), and transforaminal lumbar interbody fusion (TLIF) in terms of global sagittal alignment.
Methods : From January 2007 to December 2019, 141 adult patients who underwent multilevel interbody fusion for lumbar degenerative disorders were enrolled. Regarding the approach, patients were divided into the ALIF (n=23), OLIF (n=60), and TLIF (n=58) groups. Outcomes, including local radiographic parameters and global sagittal alignment, were then compared between the treatment groups.
Results : Regarding local radiographic parameters, ALIF and OLIF were superior to TLIF in terms of the change in the anterior disc height (7.6¡¾4.5 mm vs. 6.9¡¾3.2 mm vs. 4.7¡¾2.9 mm, p=0.000), disc angle (-10.0¡Æ¡¾6.3¡Æ vs. -9.2¡Æ¡¾5.2¡Æ vs. -5.1¡Æ¡¾5.1¡Æ, p=0.000), and fused segment lordosis (-14.5¡Æ¡¾11.3¡Æ vs. -13.8¡Æ¡¾7.5¡Æ vs. -7.4¡Æ¡¾9.1¡Æ, p=0.000). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5¡Æ¡¾9.6¡Æ vs. -44.4¡Æ¡¾11.6¡Æ vs. -40.6¡Æ¡¾12.3¡Æ, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9¡Æ¡¾11.3¡Æ vs. 6.7¡Æ¡¾11.6¡Æ vs. 11.5¡Æ¡¾13.0¡Æ, p=0.089), and the sagittal vertical axis (24.3¡¾28.5 mm vs. 24.5¡¾34.0 mm vs. 25.2¡¾36.6 mm, p=0.990) did not differ between the groups.
Conclusion : Although the anterior approaches were superior in terms of local radiographic parameters, TLIF achieved adequate global sagittal alignment, comparable to the anterior approaches.
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