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=0.000), disc angle (-10.0° ± 6.3° vs. -9.2° ± 5.2° vs. -5.1° ± 5.1°, p=0.000), and fused segment lordosis (-14.5° ± 11.3° vs. -13.8° ± 7.5° vs. -7.4° ± 9.1°, p=0.000). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5° ± 9.6° vs. -44.4° ± 11.6° vs. -40.6° ± 12.3°, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9° ± 11.3° vs. 6.7° ± 11.6° vs. 11.5° ± 13.0°, 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.