ArticleNorth American Spine Society journal2024
Transforaminal lumbar interbody fusion with or without release of the anterior longitudinal ligament: A single-center, retrospective observational cohort study.
Article in North American Spine Society journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Transforaminal lumbar interbody fusion (TLIF) with or without anterior release (TFAR) using expandable interbody spacers - comparative cohort study.Brain & spine · 2026Article
- Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery.Brain & spine · 2025Article
- Indications, complications and outcomes of minimally-invasive lateral lumbar interbody fusion with anterior column realignment vs. standard LLIF using expandable interbody spacers.Frontiers in surgery · 2024Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Transforaminal anterior release (TFAR) is a technical extension of the transforaminal lumbar interbody fusion (TLIF) procedure with deliberate release of the anterior longitudinal ligament (ALL). Methods: In a retrospective, single-center observational cohort study, consecutive adult patients undergoing TLIF surgery at L4/L5 and/or L5/S1 between 01/2018 and 12/2022 for degenerative disc disease or deformity were considered. The TFAR group (with ALL release) was compared to a standard TLIF group (without ALL release), matched in a 1:3 ratio. Uni- and multivariable logistic regression models were built to estimate the likelihood of any adverse event (AE), reoperation, and excellent/good clinical outcome at 12 months. Results: Of 438 patients, 18 undergoing TFAR were matched to 53 undergoing standard TLIF. TFAR procedures were frequently part of extensive, anterior-posterior or multilevel fusion procedures with longer surgery time and higher blood loss. The rates of intraoperative surgical AEs were similar (16.7 vs. 11.3%, p=.789). The rates and severities of surgical AEs, as well as reoperation rates and clinical outcomes were similar at time of discharge, 90 days, and 12 months postoperatively (all p>.05). TFAR allowed for an increase in total lumbar lordosis of 16.1° and in lumbar lordosis between L4 and S1 of 16.3° at discharge, which was maintained during follow-up. In both the uni- and multivariable models, patients undergoing TFAR were as likely as patients undergoing standard TLIF to experience any AE (adjusted OR 0.78, 95% CI 0.21-2.94), any reoperation (aOR 0.46, 95% CI 0.11-1.90) or excellent/good clinical outcome at 12 months (aOR 2.01, 95% CI 0.52-7.74). Conclusions: The TFAR technique has a safety profile which is comparable to the standard TLIF procedure, but it allows for a greater restoration of lumbar lordosis at L4-S1. We suggest considering the TFAR technique in selected patients with sagittal imbalance and mobile segments for restoration of lumbar lordosis.
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