Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions A Systematic Review and Meta-analysis of Comparative Studies

Study Design: Systematic review and meta-analysis. Objective: Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF). Summary of Background Data: ALIF and TLIF are 2 methods of achieving spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody technique to achieve successful radiographic and clinical outcomes. The goal of this systematic review and meta-analysis was to compare the radiographic and clinical outcomes of ALIF to TLIF. Materials and Methods: A systematic search of multiple medical reference databases was conducted for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain. Results: The search yielded 7 studies totaling 811 patients (ALIF = 448, TLIF = 363). ALIF was superior to TLIF in restoring segmental lumbar lordosis at L4-L5 and L5-S1 (L4-L5; P = 0.013, L5-S1; P < 0.001). ALIF was also superior to TLIF in restoring overall lumbar lordosis (P < 0.001). However, no significant differences in fusion rates were noted between both techniques [odds ratio = 0.905; 95% confidence interval, 0.458-1.789; P = 0.775]. In addition, ALIF and TLIF were comparable with regards to ODI and VAS scores (ODI; P = 0.184, VAS; P = 0.983). Conclusions: For the restoration of lumbar lordosis, ALIF is superior to TLIF. However, TLIF is comparable to ALIF with regards to fusion rate and clinical outcomes.