Review and analysis of modern lumbar spinal fusion techniques

Abstract

Purpose

A variety of different lumbar spinal fusion techniques have been developed. In this study, we review published medical literature highlighting the differences between lumbar interbody fusion techniques with regard to their surgical technique, clinical outcomes, and complications.

Materials and methods

PubMed, ScienceDirect, and Google Scholar searches were performed for studies published between January 1990 to April 2018 reporting spinal fusion surgery clinical outcomes of at least one fusion technique. Clinical outcomes were extracted and pooled by surgical technique. Chi-squared analyses and Fisher Exact Tests were used to determine differences in rates between groups.

Results

PLIF had the highest rate of successful fusion (97% [155/159]) and the lowest rate of complications (4% [6/131]). A chi square analysis revealed a significant difference in fusion success in PLIF compared to PLF (84% [278/330], p < .001). PLIF also had significantly fewer complications compared to PSF (14.7% [251/1709], p = .001), PLF (13.4% [47/351], p = .008), ALIF (14.2% [22/155], p = .008), and LIC (13.9% [47/339], p = .005). Additionally, there were significant differences in the rate of successful fusion when comparing lateral interbody cage (LIC) techniques (p = .041), which include OLIF (100% [63/63]), DLIF (92% [24/26]), and XLIF (87% [67/77]). LIC techniques overall had higher fusion success rates (93.0% [154/166] compared to PLF (p = .01), but a higher rate of complications (14% [47/339]) compared to PLIF (p = .005) and TLIF (6% [17/259], p = .005).

Conclusions

Overall, PLF and XLIF have the lowest fusion success rates, and OLIF demonstrated a trend of higher fusion rates among LIC. Techniques that utilized interbody fusion tended to increase the rate of fusion. While interbody fusion techniques offer higher rates of fusion, complication rates also tend to rise with the increase in complexity of the surgical technique, as with OLIF which notably has the highest fusion rate and complication rate.

Keywords:

• Spinal fusion
• posterior spinal fusion
• anterior lumbar interbody fusion
• oblique lumbar interbody fusion
• fusion rate
• complication rate

Acknowledgements

The authors acknowledge Superior Medical Experts for research, drafting, and editing assistance.

Disclosure statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Additional information

Funding

The present research was financially supported by Regions Hospital’s Medical Staff Research, Education, and Development (RED).