Contralateral bridge fixation of freehand minimally invasive pedicle screws combined with unilateral MIS-TLIF vs. open TLIF in the treatment of multi-segmental lumbar degenerative diseases: A five years retrospective study and finite element analysis

Abstract

ObjectiveTo evaluate the efficacy, safety, feasibility and biomechanical stability of contralateral bridge fixation of freehand minimally invasive pedicle screws (Freehand MIPS) combined with unilateral minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) (smile-face surgery) and open TLIF for the treatment of multi-segmental lumbar degenerative diseases (LDDs).MethodsFrom January 2013 to January 2016, clinical data of multi-segmental (2- or 3-level) LDDs receiving smile-face surgery or open TLIF were retrospectively collected and analyzed. The back and leg pain VAS and ODI were used to assess clinical outcomes preoperatively and postoperatively. The MacNab criteria were used to evaluate the satisfaction of patient. The disc height (DH), lumbar lordosis (LL) and segmental lordosis angle (SLA) were measured before and after surgery. We used patient's CT data to establish the finite element model of smile-face surgery and open TLIF, and analyze biomechanical stability of two methods.ResultsSmile-face surgery group showed shorter operation time, shorter incision, less blood loss, shorter hospital stay than open TLIF (P < 0.05). The back VAS in smile-face surgery group was significantly lower than that in open TLIF immediately and 3 months after surgery, and no significant difference was observed 1 year, 2 years and 5 years after surgery. There was no significant difference in the leg pain VAS and ODI between both groups after surgery. No significant difference was observed between two groups in the DH, LL and SLA. At 5-year follow-up, grade I or II fusion was achieved in 99.00% (100/101) segments of smile-face surgery group and 97.67% (84/86) segments of open TLIF group according to Bridwell system. The complication rate of open TLIF was higher than that of smile-face surgery (24.32% vs. 0%, P < 0.01). After verification, the established finite element model can accurately simulate the biological structure of lumbar spine and there was no significant difference in biomechanical stability between two methods.ConclusionsSmile-face surgery has some advantages over open TLIF including smaller aggression, less blood loss, and lower cost, indicating that it is a good choice of treatment for multi-segmental LDDs. Both methods can achieve good biomechanical stability.

Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis

“…The MIS-TLIF and open TLIF groups did not differ significantly in postoperative dysfunction index scores and both procedures resulted in excellent decompression. The six papers ( 15 , 17 , 18 , 21 , 22 , 24 ) returned the reported results of postoperative VAS scores, but because the results of one of them were expressed as mean and maximum-minimum and could not be calculated for conversion to standardized data, this article was discarded; with the exclusion of postoperative VAS scores for low back pain from one study ( I 2 =35%) and overall ( I 2 =47%), using a fixed-effects model, the findings revealed a statistically significant difference between the postoperative VAS values for leg pain in the MIS-TLIF and open TLIF groups (95%CI: -0.27,-0.13; P<0.00001; Fig. 12 ).…”

“…Inclusion and exclusion criteria. The inclusion criteria were: i) Patients who underwent open TLIF or MIS-TLIF for degenerative lumbar spine disease; ii) two or more surgical segments; and iii) one of the following reported in the literature: Operative time, intraoperative blood loss, postoperative drainage volume, number of intraoperative radiographs, bed rest time, hospital stay, complications, fusion rate, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) score (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The exclusion criteria were: i) Comorbidities, such as lumbar infections, neoplastic diseases, or lumbar fractures; ii) history of previous lumbar spine surgeries; iii) reviewed manuscripts, conference papers, expert opinions, case reports and literature not obtained in full text; and iv) animal experiments and biomechanical studies.…”