Psychological and Functional Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Single‐Level Lumbar Spinal Stenosis

Abstract

The aim of this study was to investigate whether treatment with minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) causes patients suffering from lumbar spinal stenosis (LSS) to experience less anxiety and better clinical efficacy than open transforaminal lumbar interbody fusion (TLIF). Methods:In this retrospective cohort study, we analyzed 86 patients, including 46 male patients and 41 female patients, who suffered from single-segmental lumbar spinal stenosis in our department between January 2016 and January 2018. They were divided into two groups: a control group (n = 46), for patients who underwent open TLIF surgery, and an experimental group (n = 40), for patients who underwent Mis-TLIF surgery. All patients were evaluated based on operation time, intraoperative blood loss, hospital stay, visual analogue scale (VAS), Oswestry disability index (ODI), hospital anxiety depression scale (HADS), fusion rate, and complications (screw misplacement and loosening, cerebrospinal fluid leakage, infection, and delayed wound healing). Patient characteristics were compared within and between groups. Results:The average incision length was 3.64 AE 0.476 cm in the experimental group, which was smaller than that (8.11 AE 2.406 cm) in the control group (P < 0.05). The operation time of the experimental group was a little longer than that of the control group. The intraoperative blood loss and hospital stay in the experimental group were less than those in the control group. The mean preoperative low back pain VAS score was 7.525 AE 1.432 in the experimental group and 7.087 AE 1.799 in the control group (P > 0.05). The low back pain VAS scores on postoperative day 3 and at 3, 6, and 12 months postoperatively were 5.000 AE 0.987, 4.075 AE 0.997, 2.150 AE 0.834, and 1.450 AE 0.639 in the experimental group, respectively; these scores were lower than those in the control group (6.870 AE 1.572, P < 0.05; 4.630 AE 1.103, P < 0.05; 2.630 AE 1.103, P < 0.05; and 2.326 AE 1.034, P < 0.05, respectively). There was no obvious difference in the leg pain VAS scores between the two groups at all follow-up points. The mean preoperative ODI score was 58.700% AE 19.703% in the experimental group and 61.696% AE 17.583% in the control group (P > 0.05). The ODI scores at postoperative months 3, 6, and 12 were 25.225% AE 5.554%, 20.150% AE 7.698%, and 16.125% AE 9.565% in the experimental group; these scores were lower than those in the control group (49.130% AE 14.805%, P < 0.05; 34.044% AE 15.148%, P < 0.05; and 29.282% AE 132.567%, P < 0.05, respectively).

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

“…One widely used operative technique among patients with degenerative disease of the lumbar spine is TLIF, which can be performed via minimally invasive surgery (MIS TLIF) or open approach (O-TLIF) [ 1 ]. While MIS TLIF and O-TLIF have been shown to demonstrate similar rates of arthrodesis, literature has reported several advantages of the former: reduced blood loss, shorter postoperative stay, and better quality-of-life outcomes related to back pain, disability, and mental functioning [ 2 ].…”

“…Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a common procedure for managing spinal pathology-induced back and/or leg pain refractory to conservative measures [ 1 ]. With an initial incision of approximately 4 cm less than that in open surgery, MIS TLIF has been shown to reduce estimated blood loss and length of stay (LOS), with patients having significantly lower postoperative back pain, disability, and hospital anxiety and depression scale scores than those undergoing open TLIF (O-TLIF) [ 2 ].…”

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

“…Since the introduction of PLIF by Cloward ( 2 , 3 ) in 1952, new techniques have been developed to accomplish lumbar interbody fusion. In 1982, TLIF, an alternative to PLIF, was introduced for the treatment of spinal degenerative diseases that necessitated interbody fusions ( 4 ). TLIF provides a more lateral surgical approach for the space of lumbar disc to reduce the retraction of dural sac and nerve root, and to avoid the postoperative midline scar that hinders the identification of neural structures in revision patients and confers the lowest post-operative disability.…”

“…However, iatrogenic paraspinal muscle injury, posterior tension band disruption, and approach-related complications are a concern ( 2 , 3 ). In recent years, minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) has been widely used in order to improve open TLIF, which can protect the attachment of paraspinal muscles to bone, avoid the disruption of supraspinous and interspinous ligaments, and decreased the bleeding and postoperative pain ( 4 ). But most studies of MIS-TLIF have focused on single-level fusion, there are relatively few reports of MIS-TLIF for two or more levels.…”

Cirugía de mínima invasión. Fusión intersomática lumbar transforaminal. Argumento de posición grupo de estudio cirugía vertebral Latinoamérica

“…open TLIF, evaluating fusion and complications; [11][12][13][14] it is concluded in favor that as it is an intermuscular approach, it respects the insertions, as well as the nerve pathways, it causes less muscle atrophy and, in some cases, an increase in paravertebral musculature when compared to open methods; 15,16 some studies, evaluating the function and connection with the patient's level of anxiety and satisfaction, suggest a possible trend in favor of the MIS-TLIF technique for ODI (Oswestry Disability Index), leg pain VAS (Visual Analog Scale of pain) and back pain VAS, this expressed in psychological analysis of the patient before the idea of a MISS procedure. 17,18…”