Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?

Both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) surgeries are performed to obtain a solid fusion to treat lumbar spondylosis. This systematic review investigated whether surgical complications, nonfusion rate, radiographic outcome, and clinical outcome of ALIF were significantly different from those of TLIF. A computerized search of the electronic databases MEDLINE was conducted. Only therapeutic studies with a prospective or retrospective comparative design were considered for inclusion in the present investigation. Two reviewers independently extracted relevant data from each included study. Statistical comparisons were made when appropriate. Nine studies were determined to be appropriate for the systematic review, and all studies were retrospective comparative studies. Blood loss and operative time in ALIF was greater than in TLIF. There was no significant difference in the complication rate between ALIF and TLIF. The restoration of disc height, segmental lordosis, and whole lumbar lordosis in ALIF was superior to TLIF. However, clinical outcomes in ALIF were similar with TLIF, and there was no significant difference in nonfusion rate between the two techniques. Costs of ALIF were greater than those of TLIF. Clinical outcomes and nonfusion rate in ALIF were similar to TLIF. However, the restoration of disc height, segmental lordosis, and whole lumbar lordosis in ALIF were superior to those in TLIF, while blood loss, operative time, and costs in ALIF were greater than in TLIF.