Comparison of Outcomes of Multi-Level Anterior, Oblique, Transforaminal Lumbar Interbody Fusion Surgery : Impact on Global Sagittal Alignment

Objective : To compare the outcomes of anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), and transforaminal lumbar interbody fusion (TLIF) in terms of global sagittal alignment.Methods : From January 2007 to December 2019, 141 adult patients who underwent multilevel interbody fusion for lumbar degenerative disorders were enrolled. Regarding the approach, patients were divided into the ALIF (n=23), OLIF (n=60), and TLIF (n=58) groups. Outcomes, including local radiographic parameters and global sagittal alignment, were then compared between the treatment groups.Results : Regarding local radiographic parameters, ALIF and OLIF were superior to TLIF in terms of the change in the anterior disc height (7.6 +/- 4.5 mm vs. 6.9 +/- 3.2 mm vs. 4.7 +/- 2.9 mm, p<0.001), disc angle (-10.0 degrees +/- 6.3 degrees vs.-9.2 degrees +/- 5.2 degrees vs.-5.1 degrees +/- 5.1 degrees, p<0.001), and fused segment lordosis (-14.5 degrees +/- 11.3 degrees vs.-13.8 degrees +/- 7.5 degrees vs.-7.4 degrees +/- 9.1 degrees, p<0.001). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5 degrees +/- 9.6 degrees vs.-44.4 degrees +/- 11.6 degrees vs.-40.6 degrees +/- 12.3 degrees, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9 degrees +/- 11.3 degrees vs. 6.7 degrees +/- 11.6 degrees vs. 11.5 degrees +/- 13.0 degrees, p=0.089), and the sagittal vertical axis (24.3 +/- 28.5 mm vs. 24.5 +/- 34.0 mm vs. 25.2 +/- 36.6 mm, p=0.990) did not differ between the groups.Conclusion : Although the anterior approaches were superior in terms of local radiographic parameters, TLIF achieved adequate global sagittal alignment, comparable to the anterior approaches.