Posterior Lumbar Fusion: A Comparison of Intertransverse Process Fusion With and Without Concomitant Interbody Fusion

PURPOSE: Single-level lumbar fusion from a posterior approach may involve an intertranverse process fusion with the possible addition of interbody devices (PLIF). A comparison of the indications and results has not been reported. The intent of this study was to compare the results, complications, and fusion rates between two spinal fusion procedures: (1) posterior lumbar interbody fusion (PLIF) and (2) posterolateral inter-transverse process fusion.

METHODS: Thirty-one patients treated with posterior lumbar interbody fusion using interbody allograft spacers with segmental pedicle screw fixation and 34 patients treated with posterolateral inter-transverse process instrumented fusions were examined. Surgical, perioperative, and follow-up data was obtained directly from medical records. The findings compared included estimated blood loss, need for blood transfusion, number of units transfused, operative time, number of days in hospital, need for transitional facility care, complications, need for further surgery, radiographic fusion and clinical results.

RESULTS: There was no significant difference in blood loss, need for transfusion, amount of blood transfused, hospital stay, transitional facility care, and complication rates when comparing the two procedures for fusion. Patients with posterior lumbar interbody fusion procedures had a higher percentage of radiographic fusion at 1 year (100%) vs the posterolateral fusion group (91%). Additionally, 90% of the posterolateral fusion group had good to excellent clinical outcome in comparison to 97% of patients undergoing posterior lumbar interbody fusions.

CONCLUSIONS: In comparing posterior lumbar interbody fusions (PLIF) and posterolateral inter-transverse process fusions, we found a higher percentage of radiographic fusion and better clinical results in patient undergoing posterior lumbar interbody fusions.