Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Abstract

Purpose The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO). Methods From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short-and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Results Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29 % in the MIS group vs. 28 % in the open group, p = 0.999). Conclusion Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.

Disc Space Preparation in Transforaminal Lumbar Interbody Fusion: A Comparison of Minimally Invasive and Open Approaches

“…This provides adequate exposure through which a unilateral facetectomy, annulotomy, and disc space preparation can be performed. MIS approaches to the TLIF have been developed with the goals of decreasing surgical morbidity, decreasing hospital stay, and hastening recovery [1,3,8,12]. However, concerns remain about the adequacy of the disc space preparation in a minimally invasive approach to the TLIF [16].…”

“…More recently, with the advent of sophisticated retractor systems and instrumentation, minimally invasive approaches to the TLIF have become popular in an attempt to decrease surgical morbidity and length of hospital stay and hasten recovery [1,3,8,12]. However, concerns remain regarding the adequacy of disc space preparation that can be achieved through a minimally invasive approach to TLIF [16].…”

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

“…The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group (n = 11 studies) [10][11][12][16][17][18][19][20][21][22][23]. The estimated blood loss was generally and significantly lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively (n = 13 studies) [10][11][12][13][15][16][17][18][19][20][21][22][23].…”

“…The articles that included revision surgery (8) or more than a single level treated (6) or without the complications were also excluded. Eventually, 14 studies which met our inclusion criteria were included in the present systematic review [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The selection process for articles included in the review is shown in Fig.…”

Expert’s comment concerning Grand Rounds case entitled “Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis” (by Nasir A. Quraishi and Y. Raja Rampersaud; doi:10.1007/s00586-012-2623-2)

“…15, 81377 Munich, Germany e-mail: cbirkenm@med.uni-muenchen.de [2] as well as for those treated with instrumented posterolateral fusion [3].…”