The spine journal : official journal of the North American Spine Society
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Addition of interbody fusion via a transforaminal approach (TLIF) has become a popular surgical option for treatment of degenerative lumbar conditions. Although technically more complicated than posterolateral fusion surgery (PLF), it has been suggested that TLIF provides superior immediate stability and protects against early pedicle screw loosening. This theory has never been formally examined in a clinical study. ⋯ TLIF appears to have a protective effect, reducing rates of early screw loosening by approximately 60% versus PLF. However, this effect appears independent of actual overall radiographic fusion rates which may be approximately 20% lower with TLIF at 12 months. TLIF may have advantages in patients where early loosening is a particular concern, for example, in the setting of increased patient age.