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.
Consecutively treated patients with lumbar pathology who underwent MIDLF ( = 16) and a historical control group who underwent MI-TLIF ( = 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.
The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min . 229 min, < 0.001; 0.34 . 0.36, = 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 ( = 0.018).
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.

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