# Comparison of Hybrid Dynamic Stabilization with TLIF Versus Dynamic Stabilization Alone in Degenerative Lumbar Instability

## TL;DR

This study compared two surgical approaches for lumbar instability and found that combining dynamic stabilization with TLIF improves outcomes without increasing risks.

## Contribution

The study introduces hybrid dynamic stabilization with TLIF as a balanced strategy for treating degenerative lumbar instability.

## Key findings

- Hybrid group showed significantly higher anterior fusion rates and better pain improvement at 12 months.
- Hybrid group maintained better lumbar lordosis and adjacent segment disk height index.
- No significant increase in adjacent segment disease or pseudoarthrosis in the hybrid group.

## Abstract

Objective: This study aimed to compare the clinical and radiological outcomes of dynamic rod stabilization with and without transforaminal lumbar interbody fusion (TLIF) in patients undergoing surgery for degenerative lumbar instability. Specifically, we evaluated the prognostic value of hybrid systems in reducing adjacent segment disease (ASD), enhancing fusion rates, and improving functional outcomes. Methods: A retrospective analysis was conducted on 62 patients treated between 2019 and 2022. Group 1 (n = 34) underwent dynamic rod stabilization alone, while Group 2 (n = 28) received dynamic stabilization combined with TLIF. Radiological assessments included disk height index (DHI) and fusion rates. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain at baseline, 12, and 24 months. Statistical analysis was performed using Jamovi® software (version 2.4.1). Results: The hybrid group (dynamic + TLIF) demonstrated significantly higher anterior fusion rates (p < 0.001) and greater improvement in VAS scores for back (p = 0.005) and leg pain (p < 0.001) at 12 months. Although operative time was longer (p = 0.002), there was no significant difference in hospital stay (p = 0.635). No significant differences were observed in ASD development (p = 0.11) or pseudoarthrosis (p = 0.396). The hybrid group maintained better lumbar lordosis and higher adjacent segment DHI. Conclusions: Hybrid dynamic stabilization combined with TLIF provides superior clinical outcomes and fusion rates compared to dynamic stabilization alone, without significantly increasing the risk of ASD. These findings support the use of hybrid constructs as a balanced strategy for treating degenerative lumbar instability.