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

Abstract

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.

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

“…10,11 Transforaminal lumbar interbody fusion (TLIF) has been shown to be an effective surgical procedure for spondylolisthesis, 4,9,13,22 and there is growing interest in whether minimally invasive surgery for TLIF (MIS TLIF) can provide the same benefits. 1,3,16,35 Although MIS TLIF is associated with a significant learning curve, increased use of fluoroscopy, and risk of nerve injury, 2,6,[26][27][28][44][45][46][47] its benefits over open TLIF include decreased operating time, decreased intraoperative blood loss, decreased hospital stay, improved cost-effectiveness, faster return to work, and decreased pain. 20,24,29,32,[37][38][39]42 One controversy with MIS TLIF is the ability to provide adequate reduction of spondylolisthesis and correction of radiographic parameters, or even whether such changes are necessary.…”

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) for Spondylolisthesis in 282 Patients: In Situ Arthrodesis versus Reduction

“…This is in line with Lian et al (23) in which the authors employed posterior lumbar interbody fusion (PLIF, 119 minutes for reduction and 125 for in situ fusion). Nonetheless, the operative time in the present cohort was approximately 100 minutes longer than theirs (228 minutes and 222 minutes, respectively), which is not uncommon for MI-TLIF for spondylolisthesis correction (33,49). And despite having a larger and technically more involved procedure, patients who underwent reduction had similar length of hospital stay and similar disposition to home.…”

“…Minimally invasive TLIF is an effective surgical option for the management of spondylolisthesis (7,33,34,44,45,49). However, it still remains controversial whether to reduce the spondylolisthesis or to fuse in situ (4,23,24,36,46).…”

Minimally invasive techniques for lumbar decompressions and fusions

“…Direct comparisons between MIS and open TLIF support equivalent improvements in disability, pain, and quality-oflife metrics at time points up to 3 years postoperatively [32,35,36]. Longer follow-up periods have also been reported, with Park et al analyzing a cohort of 83 MIS TLIF patients with 5-year follow-up [37]. Clinically, patients demonstrated a 36-point improvement in Oswestry Disability Index (ODI), along with a 3.2-point improvement in Visual Analogue Scale (VAS) back pain and a 6.7-point improvement in VAS leg pain scores.…”