{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:39:53Z","timestamp":1772109593930,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017638","name":"Ministry of Health of the Russian Federation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017638","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Different fusion techniques were introduced in clinical practice in patients with lumbar degenerative disc disease, however, no evidence has been provided on the advantages of one technique over another.<\/jats:p><\/jats:sec><jats:sec><jats:title>The Objective of This Study<\/jats:title><jats:p>Is to assess the potential impact of circumferential fusion employing transforaminal lumbar interbody fusion (TLIF) vs. direct lateral interbody fusion (DLIF) on pedicle screw stability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This is a single-center prospective evaluation of consecutive 138 patients with degenerative instability of lumbar spinal segments. Either conventional transforaminal lumbar interbody fusion (TLIF) with posterior fusion or direct lateral interbody fusion (DLIF) using cages of standard dimensions, were applied. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was used in patients treated with DLIF. The duration of the follow-up accounted for 24 months. Signs of pedicle screws loosening (PSL) and bone union after fusion were assessed by the results of CT imaging. Fisher\u2018s exact test was used to assess the differences in the rate of CT loosening and revision surgery because of implant instability. Logistic regression was used to assess the association between potential factors and complication rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rate of PSL detected by CT and relevant revision surgery in groups treated with TLIF and DLIF accounted for 25 (32.9%) vs. 2 (3.2%), respectively, for the former and 9 (12.0%) vs. 0 (0%) for the latter (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001 and <jats:italic>p<\/jats:italic> = 0.0043) respectively. According to the results of logistic regression, a decrease in radiodensity values and a greater number of levels fused were associated with a rise in PSL rate. DLIF application in patients with radiodensity below 140 HU was associated with a considerable decrease in complication rate. Unipolar or bipolar pseudoarthrosis in patients operated on with TLIF was associated with a rise in PSL rate while patients treated with DLIF tolerate delayed interbody fusion formation. In patients treated with TLIF supplementary total or partial posterior fusion resulted in a decline in PSL rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Even though the supplementary posterior fusion may considerably reduce the rate of PSL in patients treated with TLIF, the application of DLIF provide greater stability resulting in a substantial decline in PSL rate and relevant revision surgery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.827999","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T13:03:47Z","timestamp":1652706227000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Circumferential Fusion Employing Transforaminal vs. Direct Lateral Lumbar Interbody Fusion\u2014A Potential Impact on Implants Stability"],"prefix":"10.3389","volume":"9","author":[{"given":"Andrey","family":"Bokov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svetlana","family":"Kalinina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Leontev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergey","family":"Mlyavykh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.3171\/2014.4.SPINE14274","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis","volume":"21","author":"Resnick","year":"2014","journal-title":"J Neurosurg Spine."},{"key":"B2","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3171\/2014.4.SPINE14271","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy","volume":"21","author":"Wang","year":"2014","journal-title":"J Neurosurg Spine."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1060","DOI":"10.1016\/j.wneu.2018.05.165","article-title":"Radiological and clinical comparison of posterolateral fusion and transforaminal interbody fusion techniques in degenerative lumbar stenosis","volume":"116","author":"Bozkurt","year":"2018","journal-title":"World Neurosurg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s11420-019-09734-7","article-title":"Lateral lumbar interbody fusion: what is the evidence of indirect neural decompression? A systematic review of the literature","volume":"16","author":"Formica","year":"2020","journal-title":"HSS J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3978\/j.issn.2414-469X.2015.10.05","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","journal-title":"J Spine Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2015.7.FOCUS15278","article-title":"Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature","volume":"39","author":"Joseph","year":"2015","journal-title":"Neurosurg Focus."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e286","DOI":"10.1016\/j.wneu.2019.05.130","article-title":"Comparison of anterior approach and posterior approach to instrumented interbody fusion for spondylolisthesis: a meta-analysis","volume":"129","author":"Cho","year":"2019","journal-title":"World Neurosurg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1007\/s10143-016-0806-8","article-title":"Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis","volume":"41","author":"Keorochana","year":"2018","journal-title":"Neurosurg Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/2192568219832853","article-title":"Wide variability in patient-reported outcomes measures after fusion for lumbar spinal stenosis: a systematic review","volume":"10","author":"Winebrake","year":"2020","journal-title":"Global Spine J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"979","DOI":"10.2147\/JPR.S92776","article-title":"Failed back surgery syndrome: current perspectives","volume":"9","author":"Baber","year":"2016","journal-title":"J Pain Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3233\/BMR-150318","article-title":"The aetiologies of failed back surgery syndrome: a systematic review","volume":"30","author":"Clancy","year":"2017","journal-title":"J Back Musculoskelet Rehabil."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1007\/s00586-020-06386-8","article-title":"Hounsfield units value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases","volume":"29","author":"Zou","year":"2020","journal-title":"Eur Spine J."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1177\/2192568220975365.","article-title":"Average lumbar hounsfield units predicts osteoporosis-related complications following lumbar spine fusion","author":"St Jeor","year":"2020","journal-title":"Global Spine J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1109\/EMBC.2019.8856592","article-title":"XLIF interbody cage reduces stress and strain of fixation in spinal reconstructive surgery in comparison with TLIF cage with bilateral or unilateral fixation: a computational analysis","volume":"2019","author":"Zhang","year":"2019","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e890","DOI":"10.1016\/j.wneu.2019.06.074","article-title":"Comparison of biomechanical performance among posterolateral fusion and transforaminal, extreme, and oblique lumbar interbody fusion: a finite element analysis","volume":"129","author":"Lu","year":"2019","journal-title":"World Neurosurg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1148\/radiol.2451051359","article-title":"Lumbar intervertebral instability: a review","volume":"245","author":"Leone","year":"2007","journal-title":"Radiology."},{"key":"B17","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/2192568217712494","article-title":"Lumbar interbody fusions for degenerative spondylolisthesis: review of techniques, indications, and outcomes","volume":"9","author":"Spiker","year":"2019","journal-title":"Global Spine J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1007\/s00586-007-0376-0","article-title":"CT-based classification of long spinal allograft fusion","volume":"16","author":"Tan","year":"2007","journal-title":"Eur Spine J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1097\/00007632-200103010-00018","article-title":"Interobserver and intraobserver agreement of radiograph interpretation with and without pedicle screw implants: the need for a detailed classification system in posterolateral spinal fusion","volume":"26","author":"Christensen","year":"2001","journal-title":"Spine."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1097\/BRS.0000000000003558","article-title":"Dutch Clinical Spine Research Group. Increasing Fusion Rate Between 1 and 2 Years After Instrumented Posterolateral Spinal Fusion and the Role of Bone Grafting","volume":"45","author":"Lehr","year":"2020","journal-title":"Spine."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1007\/s00586-015-3768-6","article-title":"Pedicle screw loosening: a clinically relevant complication?","volume":"24","author":"Galbusera","year":"2015","journal-title":"Eur Spine J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/s00402-011-1439-6","article-title":"A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws","volume":"132","author":"Wu","year":"2012","journal-title":"Arch Orthop Trauma Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00402-016-2487-8","article-title":"Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery","volume":"136","author":"Bredow","year":"2016","journal-title":"Arch Orthop Trauma Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1016\/j.mspro.2014.07.065","article-title":"Analysis of Hounsfield unit of human bones for strength evaluation","volume":"6","author":"Khan","year":"2014","journal-title":"Procedia Mater Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.3174\/ajnr.A3893","article-title":"Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening","volume":"35","author":"Schwaiger","year":"2014","journal-title":"AJNR Am J Neuroradiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"E239","DOI":"10.1097\/BRS.0000000000002813","article-title":"Measurement techniques and utility of hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature","volume":"44","author":"Zaidi","year":"2019","journal-title":"Spine."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e4","DOI":"10.2349\/biij.7.1.e4","article-title":"Image-guided facet joint injection","volume":"7","author":"Peh","year":"2011","journal-title":"Biomed Imaging Interv J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"545","DOI":"10.36076\/ppj.2011\/14\/545","article-title":"An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression","volume":"14","author":"Bokov","year":"2011","journal-title":"Pain Physician."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1186\/s40064-016-2694-3","article-title":"Biomechanical study of rotational micromovement of the pedicle screw","volume":"5","author":"Mizuno","year":"2016","journal-title":"Springerplus."},{"key":"B30","doi-asserted-by":"publisher","first-page":"178","DOI":"10.21037\/jss.2016.09.08","article-title":"The importance of loading the periphery of the vertebral endplate","volume":"2","author":"Cadman","year":"2016","journal-title":"J Spine Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1007\/s00586-013-2760-2","article-title":"Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up","volume":"22","author":"H\u00f8y","year":"2013","journal-title":"Eur Spine J."},{"key":"B32","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1177\/2192568221997804","article-title":"Effects and safety of lumbar fusion techniques in lumbar spondylolisthesis: a network meta-analysis of randomized controlled trials","volume":"12","author":"Kang","year":"2021","journal-title":"Global Spine J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1111\/os.12086","article-title":"The \u201cTFP\u201d fusion technique for posterior 360\u00b0 lumbar fusion: a combination of open decompression, transforaminal lumbar interbody fusion, and facet fusion with percutaneous pedicle screw fixation","volume":"6","author":"Rao","year":"2014","journal-title":"Orthop Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1227\/01.NEU.0000103493.25162.18","article-title":"Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients","volume":"54","author":"Salehi","year":"2004","journal-title":"Neurosurgery"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.827999\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T13:03:50Z","timestamp":1652706230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.827999\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,16]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2022.827999"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.827999","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,16]]},"article-number":"827999"}}