Salvage Procedures for Pseudarthrosis After Transforaminal Lumbar Interbody Fusion (TLIF) — Anterior-Only Versus Anterior–Posterior Surgery: A Clinical and Radiological Outcome Study


A retrospective review was performed to analyze the radiographic and functional outcomes of two different surgeries to repair a pseudarthrosis following a transforaminal lumbar interbody fusion (TLIF) procedure. Although there are several published reports on the results of the TLIF procedure, there are no reports on how to salvage a failed TLIF. A total of 38 consecutive patients with failed TLIF procedures (at 50 levels) were repaired by either a direct anterior approach only (21 patients) or by a combined direct anterior approach coupled with a posterior exploration and pseudarthrosis repair (17 patients). The minimum follow-up after revision was 24 months. Clinical outcome was measured by Oswestry Disability Index, Roland Morris Questionnaire, SF-36, and the authors’ own centers’ satisfaction questionnaire in 17 of the 38 patients. The fusion rate for the anterior-alone group was 81% (17/21) and 88% (15/17) for the anterior-posterior group, not a statistically significant difference. The Oswestry scores averaged 56.4 for the anterior lumbar interbody fusion (ALIF) group and 51.4 for the anterior-posterior fusion (APF) group. The Roland-Morris scores averaged 18.9 for the ALIF group and 20.0 for the APF group. The SF-36 showed similar outcomes in both groups. The authors’ center’s satisfaction questionnaire also showed similar results. The outcomes, both radiologic and functional, were equal in both groups. There was very little improvement in functional outcomes comparing prerepair to postrepair based on the authors’ questionnaire. (Journal of Surgical Orthopaedic Advances 18(4):200–204, 2009)

Hector A. Vargas-Soto, MD, Amir Mehbod, MD, Kevin J. Mullaney, MD, Daryll Dykes,
MD, PhD, James Schwender, MD, Ensor Transfeldt, MD, Burak Akesen, MD, and Jill
Wroblewski, MS