Anterior to Psoas Fusion versus Minimally Invasive Transforaminal Fusion with Cortical Bone Trajectory Fixation for Single-Level Lumbar Degenerative Disc Disease

Objective: To compare the clinical and radiological outcomes between an anterior to psoas (ATP) ap-proach combined with cortical bone trajectory (CBT) fixation (ATP group) and minimally invasive trans-foraminal lumbar interbody fusion (MI-TLIF) combined with CBT fixation (MI-TLIF group) for treating patients with lumbar degenerative disc disease and instability. Methods: This retrospective study included patients who underwent interbody fusion and internal fixa-tion between May 1, 2019, and September 30, 2020, using the ATP or MI-TLIF approach to treat degen-erative lumbar disc disease and instability. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) results, blood loss, operation time, complications, and bony fusion were analyzed and compared to understand clinical outcomes. Clinical and radiologic follow-up for all patients was at least 12 months. Results: The ATP approach combined with CBT fixation resulted in less blood loss, earlier reduced VAS scores, better ODI scores, but longer operation time. At 12 months, the fusion rates in the ATP and MI-TLIF groups were 90% (18/20) and 72% (13/18), respectively. Conclusion: Our results show that the ATP approach combined with CBT fixation had the advantage of less blood loss, earlier recovery in VAS scores, and better ODI than in MI-TLIF. Indirect and direct de-compression could be successfully integrated by the ATP approach combined with CBT fixation and laminectomy.Copyright (c) 2023, Taiwan Society of Geriatric Emergency & Critical Care Medicine.