A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The optimal minimally invasive surgery (MIS) approach for grade 1 lumbar spondylolisthesis is not clearly elucidated. In this study, the authors compared the 24-month patient-reported outcomes (PROs) after MIS transforaminal lumbar interbody fusion (TLIF) and MIS decompression for degenerative lumbar spondylolisthesis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 608 patients from 12 high-enrolling sites participating in the Quality Outcomes Database (QOD) lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis, of whom 143 underwent MIS (72 MIS TLIF [50.3%] and 71 MIS decompression [49.7%]). Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse plane MIS intervertebral body graft (MIS TLIF) or if there was a tubular decompression (MIS decompression). Parameters obtained at baseline through at least 24 months of follow-up were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain, NRS for leg pain, EuroQol-5D (EQ-5D) questionnaire, and North American Spine Society (NASS) satisfaction questionnaire. Multivariate models were constructed to adjust for patient characteristics, surgical variables, and baseline PRO values.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The mean age of the MIS cohort was 67.1 ± 11.3 years (MIS TLIF 62.1 years vs MIS decompression 72.3 years) and consisted of 79 (55.2%) women (MIS TLIF 55.6% vs MIS decompression 54.9%). The proportion in each cohort reaching the 24-month follow-up did not differ significantly between the cohorts (MIS TLIF 83.3% and MIS decompression 84.5%, p <jats:italic>=</jats:italic> 0.85). MIS TLIF was associated with greater blood loss (mean 108.8 vs 33.0 ml, p &lt; 0.001), longer operative time (mean 228.2 vs 101.8 minutes, p &lt; 0.001), and longer length of hospitalization (mean 2.9 vs 0.7 days, p <jats:italic>&lt;</jats:italic> 0.001). MIS TLIF was associated with a significantly lower reoperation rate (14.1% vs 1.4%, p = 0.004). Both cohorts demonstrated significant improvements in ODI, NRS back pain, NRS leg pain, and EQ-5D at 24 months (p &lt; 0.001, all comparisons relative to baseline). In multivariate analyses, MIS TLIF—as opposed to MIS decompression alone—was associated with superior ODI change (β = −7.59, 95% CI −14.96 to −0.23; p = 0.04), NRS back pain change (β = −1.54, 95% CI −2.78 to −0.30; p = 0.02), and NASS satisfaction (OR 0.32, 95% CI 0.12–0.82; p = 0.02).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>For symptomatic, single-level degenerative spondylolisthesis, MIS TLIF was associated with a lower reoperation rate and superior outcomes for disability, back pain, and patient satisfaction compared with posterior MIS decompression alone. This finding may aid surgical decision-making when considering MIS for degenerative lumbar spondylolisthesis.</jats:p></jats:sec>

Comparison of Clinical Outcomes Following Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis With Degenerative Spondylolisthesis

“…Therefore, various minimally invasive techniques were developed to minimize the surgical trauma (20)(21)(22). Patients of LSS with degenerative spondylolisthesis could be treated by both decompression alone and decompression with instrumented fusion (2,12). LE-ULBD and MI-TLIF are two common minimally invasive procedures to treat LSS with degenerative spondylolisthesis.…”

“…Even though there are growing evidences suggest that decompression alone is of excellent clinical outcome for LSS with degenerative spondylolisthesis, it is still controversial for the necessity of arthrodesis (8,12,(27)(28)(29)(30). Ghogawala et al (8) found that decompression alone may destabilize the spine in patients of LSS with degenerative spondylolisthesis, resulting in increasing back pain and reoperation.…”

“…Ghogawala et al (8) found that decompression alone may destabilize the spine in patients of LSS with degenerative spondylolisthesis, resulting in increasing back pain and reoperation. Chan et al (12) found that MI-TLIF was associated with superior outcomes for disability, back pain, and patient satisfaction and fewer reoperations compared with posterior minimally invasive decompression alone. LE-ULBD could preserve the posterior supporting elements and is recognized to be effective, with the potential to avoid further slip progression.…”

“…Even though both decompression alone and decompression plus instrumented fusion has been performed to treat patients of LSS with degenerative spondylolisthesis, it is controversial about the necessity of instrumented fusion after decompression (2,7,8,12). The purpose of the present retrospective study is to compare the clinical outcomes, safety and complications of LE-ULBD and MI-TLIF to treat one-level LSS with degenerative spondylolisthesis.…”

“…Decompression with instrumented fusion was thought as the "criterion standard" treatment for LSS with degenerative spondylolisthesis (7)(8)(9). Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) was firstly described by Foley et al and had been commonly performed to treat LSS with degenerative spondylolisthesis (10)(11)(12). Decompression alone was also used to treat LSS with degenerative spondylolisthesis to preserve the facet joints, paraspinal musculoligamentous structures, mitigate the risk of adjacent segment fusions after instrumented fusion, and to reduce the healthcare cost (2).…”