Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications

Holly, Langston T.; Schwender, James D.; Rouben, David; Foley, Kevin T.

doi:10.3171/foc.2006.20.3.7

Cited by 278 publications

(178 citation statements)

References 23 publications

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“…Symptomatic misplaced pedicle screws (2%) and cage migration (2%) were also reported. Our complication and reoperation rates appear comparable to other results of minimally invasive transforaminal lumbar interbody fusion [3,4,6,8,14,16,19,[22][23][24][25]. In the series of Rouben et al [22], the overall rate for repeat surgery (14.2%) was higher than ours.…”

Section: Discussionsupporting

confidence: 86%

“…Multiple studies have reported favorable results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion [3,4,6,14,16,17,[20][21][22][23][24][25]. These studies described results from 6 to 49 months postoperatively; however, to our knowledge, 5-year followup data have never been reported.…”

Section: Discussionmentioning

confidence: 90%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. Questions/purposes We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. Methods We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003)(2004)(2005)(2006)(2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. Results At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. Conclusions Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 90%

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Since this procedure reduces the approachrelated muscle damage, blood loss, postoperative pain, length of stay in hospital, and postoperative narcotic usage, and allows early ambulation, it is popularized by most of the spine surgeons especially when used with percutaneous pedicle screws (6,10,18).…”

Section: Sonmez E Et Al: Unilateral Percutaneous Pedicle Screw Instrmentioning

confidence: 99%

Unilateral percutaneous pedicle screw instrumentation with minimally invasive tlif for the treatment of recurrent lumbar disk disease. 2 years follow-up

Sonmez¹,

Çöven²,

Şahintürk³

et al. 2012

Turkish Neurosurgery

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AIm:To compare the clinical and radiological outcomes of recurrent disk disease in patients who underwent unilateral and bilateral percutaneous pedicle screw instrumentation with Mis-TLIF. mAterIAl and methOds: 10 patients treated with unilateral percutaneous instrumentation plus Mis-TLIF formed Group 1 while the other 10 patients treated with bilateral percutaneous instrumentation plus Mis-TLIF formed Group 2. Clinical outcomes were graded using the visual analog scale (VAS) and the Oswestry disability index (ODI) scores. Peroperative and 2-year follow-up scores were obtained. Postoperative imaging techniques were used for the assessment of fusion, subsidence and spinal alignment.results: According to preoperative and postoperative VAS/ODI scores, statistically significant differences were noted in the unilaterally and bilaterally instrumented group. However, a statistically significant difference was not observed between the unilateral and bilateral groups. Radiological evidence of successful arthrodesis was noted in 8 of 10 patients (80%) in the unilaterally instrumented group and in 9 of 10 patients (90%) in the bilaterally instrumented group at the 2 years follow-up. No metal failure, cage migration, vertebral fracture, subsidence or adjacent level disease was experienced.COnClusIOn: Mis-TLIF with unilateral percutaneous pedicle screw instrumentation is an excellent option in the treatment of selected recurrent disk disease patients.

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“…The authors of comparative studies involving open and MIS techniques for interbody fusion have reported complication rates that were comparable but the sizes of populations have been small and the studies were mostly retrospective or lacked a control group [1,3,7,8,14]. In some studies of less invasive techniques, however, investigators revealed an increase in perioperative morbidity, namely neurological sequelae [4].…”

Section: Complications Reoperations and Radiographic Outcomementioning

confidence: 99%

“…Several studies have reported the favorable outcomes of MIS-TLIF accompanied by spinal instrumentation with percutaneous pedicle screw insertion and decompression in degenerative spondylolisthesis [1,3,5,12,20,21,23,25]. In the presence of severe spinal canal stenosis and distorted facet anatomy due to severe FJO, MIS techniques however could limit direct visualization of neural elements and pedicle screws relative to key anatomical structures and could increase the rate of complications and pedicle screw misplacement.…”

Section: Introductionmentioning

confidence: 99%

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

Archavlis

Nievas²

2013

Eur Spine J

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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.

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Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications

Cited by 278 publications

References 23 publications

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Unilateral percutaneous pedicle screw instrumentation with minimally invasive tlif for the treatment of recurrent lumbar disk disease. 2 years follow-up

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

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