Objective:

We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.

Methods:

Consecutively treated patients with lumbar pathology who underwent MIDLF ( n = 16) and a historical control group who underwent MI-TLIF ( n = 34) were included. Clinical symptoms were evaluated using Oswestry Disability Index (ODI), the 36-Item Short-Form Health Survey, and visual analog scale (VAS) scores before surgery and 3, 6, 12, and 24 months after surgery.

Results:

The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min vs. 229 min, P < 0.001; 0.34 vs. 0.36, P = 0.037). The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively. VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months. At 24 months follow-up, VAS back pain was higher in MI-TLIF than in MIDLF cases ( P = 0.018).

Conclusion:

MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.