Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion

Abstract

Study DesignRetrospective cohort study.PurposeComparison between three different minimally invasive surgical (MIS) fusion techniques for single-level lumbar spondylolisthesis.Overview of LiteratureThere has been an increase in the development and utilization of MIS techniques for lumbar spine fusion. No study has compared the efficacy of MIS-posterolateral fusion (MIS-PLF), MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) with modified cortical bone trajectory screws for lumbar spondylolisthesis.MethodsFifty-nine patients with single-level lumbar spondylolisthesis and a minimum follow-up period of 1 year were included in this study. The MIS-PLF, MIS-TLIF, and MIDLF groups included 22, 15, and 22 patients, respectively. The average age of the groups was 70.6, 49.3, and 62.7 years, respectively. The evaluation parameters were operation time, intraoperative bleeding, serum C-reactive protein (CRP) value, creatine kinase (CK) value, and overall functional outcome as per the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score. The changes in the lumbar lordosis angle (LLA), segmental disc angle (SDA), and disc height were measured. Fusion rate, screw loosening, and loss of correction were also assessed.ResultsMIDLF showed a significantly shorter operation time (111 min), less bleeding amount (112.5 mL), and lower values of CRP and CK than the other two techniques. There was no significant difference in the JOABPEQ scores of the three groups. MIDLF resulted in a greater increase in the LLA and SDA postoperatively. MIDLF and MIS-TLIF resulted in a significant increase in the middle disc height compared with MIS-PLF. MIDLF showed a lower loss of correction after 6 months postoperatively (2.6%) than MIS-PLF (5.2%) and MIS-TLIF (4.2%). The fusion rate was 100% in the MIDLF and MIS-TLIF groups and 90% in the MIS-PLF group. Screw loosening occurred in 10% of the MIS-PLF cases, 7.14% of the MIS-TLIF cases, and 4.76% of the MIDLF cases.ConclusionsMIDLF was the least invasive, and there was no significant difference between the three groups in terms of fusion, screw loosening, and clinical outcomes.

Risk Factor Analysis of Proximal Junctional Kyphosis after Surgical Treatment of Adult Spinal Deformity with Oblique Lateral Interbody Fusion

“…In staged surgery, patients wore a hard brace, and their activity was restricted to a wheelchair while waiting for the second-stage posterior surgery, which was performed in the prone position a week after the first-stage surgery. In posterior surgery, fixation points were obtained using modified cortical bone trajectory screws, as previously reported [ 20 ]. A posterior column osteotomy (PCO), and additional transforaminal interbody fusion (TLIF) was selected as the corrective technique based on patient characteristics for each case.…”

Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Surgical Management of Post-Discectomy Syndrome

“…Elmekaty et al [25] compared in a series of 59 patients with single-level lumbar spondylolisthesis MIS-posterolateral fusion, MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) and concluded that MIDLF to be the least invasive. Furthermore, there was no difference regarding fusion and functional outcomes.…”

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

“…Although minimally invasive direct surgical treatments for lumbar spondylolysis have been well described [ 1 – 3 ] and minimally invasive instrumented fusion techniques are nowadays often selected to treat patients with lumbar spondylolisthesis [ 4 – 10 ], we believe that the addition in the literature of short illustrative surgical reports specifically addressing the surgical nuances and technical challenges associated with minimally invasive direct pars fracture decompression for isthmic spondylolysis with spondylolisthesis could be of benefit to surgeons in training and surgeons in the early stages of their minimally invasive surgery learning curve. The presence of fibrous pseudo-healing near the fracture line may in fact pose a surgical anatomy challenge that is not seen in degenerative spondylolisthesis, especially if combined to the relatively limited exposure allowed by a tubular approach.…”