ArticleBrain & spine2026
Transforaminal lumbar interbody fusion (TLIF) with or without anterior release (TFAR) using expandable interbody spacers - comparative cohort study.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Transforaminal lumbar interbody fusion (TLIF) can be extended by transforaminal anterior release (TFAR), to open and distract degenerated segments and increase segmental lordosis (SL). Research question: To analyze the rate, type and severity of adverse events (AEs), as well as spinopelvic parameters and clinical outcomes. Material and methods: We reviewed consecutive patients treated with TLIF with expandable interbody spacers. TFAR patients were matched 1:5 to a control group (conventional TLIF). Results: We identified n = 435 patients (541 TLIF levels; mean age 65.2 years; 55.7% female), of which n = 30 patients (39 levels) were assigned to the TFAR group and n = 149 (247 TLIF levels) to the control group. TFAR procedures took longer (mean difference (MD) 86min, p = 0.004) and had a higher blood loss (MD 463 ml, p = 0.022). In multivariable analysis, TFAR patients were more likely to experience intraoperative AEs (OR 3.49, 95% CI 1.47 - 8.31, p = 0.005) and early postoperative AEs (OR 2.39, 95% CI 0.99 - 5.76, p = 0.051), while the risk for further AEs at 90 days and 12 months was similar. Patients in the TFAR group were more likely to achieve a favorable 12-month outcome (OR 2.71, 95% CI 1.13 - 6.51, p = 0.025). TFAR patients had consistently more SL during follow-up (12 month: 24.9° vs. 18.9°, p < 0.001) and the pelvic incidence (PI)-LL mismatch was lower (0.4° vs. 7.2°, p = 0.020). Discussion and conclusion: We found a 3-fold increase in intraoperative and early postoperative AEs in TFAR patients, while the mid- and longer-term outcomes were similar or even slightly better than in patients undergoing conventional TLIF.
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