Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Anterior Lumbar Interbody Fusion with Posterior Instrumentation at L5/S1

Jacob, Kevin C.; Patel, Madhav R.; Ribot, Max A.; Parsons, Alexander W.; Vanjani, Nisheka N.; Pawlowski, Hanna; Prabhu, Michael C.; Singh, Kern

doi:10.1016/j.wneu.2021.09.108

Cited by 8 publications

(26 citation statements)

References 35 publications

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“…MCID achievement rates in our study were markedly higher among MIS TLIF patients for ODI at 6 weeks and 12 weeks, PROMIS-PF at 12 weeks, and VAS leg at 6 weeks and 12 weeks. Our results thus contrast the early postoperative results of Jacob et al, 9 which demonstrated increased MCID achievement at early time points across several PROMs for ALIF patients. This finding is important to expand on because ALIF has been shown to effectively reduce leg pain by indirect decompression.…”

Section: Discussioncontrasting

confidence: 99%

“…There may be variability between our insignificant disability results versus those of this study because we present findings from a single surgeon limiting generalizability, and surgeries were conducted between 2007 and 2021 while Kim et al studied subjects undergoing procedures from 2001 to 2004. 12 Furthermore, while Jacob et al 9 demonstrated superior PROMs for ALIF in the initial weeks after fusion, our results indicate that on controlling for isthmic spondylolisthesis pathology, such differences subside.…”

Section: Discussionmentioning

confidence: 44%

“…7 Minimally invasive TLIF (MIS TLIF) is an emerging technique, which has the potential to improve patient care by reducing blood loss, softtissue disruption, and the length of hospital stay. 7,8 Jacob et al 9 compared single-level MIS TLIF versus ALIF at L5/S1 among a population of patients with heterogeneous spinal pathologies including degenerative spondylolisthesis, isthmic spondylolisthesis, recurrent herniated nucleus pulposus, and degenerative scoliosis, reporting that the MIS TLIF cohort had markedly less surgical time, blood loss, and hospital length of stay, with higher overall MCID achievement for leg pain. Meanwhile, the ALIF cohort had markedly better PROM scores and MCID achievement in the early postoperative period for physical functioning, disability, and back pain.…”

mentioning

confidence: 99%

“…Meanwhile, the ALIF cohort had markedly better PROM scores and MCID achievement in the early postoperative period for physical functioning, disability, and back pain. 9 Phan et al 10 conducted a meta-analysis comparing ALIF versus TLIF and reported that both had similar fusion rates and clinical outcomes. How-ever, neither of these studies focused uniquely on patients with isthmic spondylolisthesis, an objective which only a few studies have assessed.…”

mentioning

confidence: 99%

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Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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Introduction:Limited studies have compared minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with anterior lumbar interbody fusion (ALIF) for the treatment of isthmic spondylolisthesis. This study aims to compare perioperative variables, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates between these surgical approaches.Methods:Patients with isthmic spondylolisthesis undergoing primary, single-level MIS TLIF or ALIF were identified in a surgical database. Patients were divided into MIS TLIF and ALIF cohorts. Demographics and perioperative characteristics were collected and compared between groups using the chi square test or Student t-test. PROMs including the Patient-Reported Outcomes Measurement Information System Physical Function, 12-Item Short Form Physical Composite Score, visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index were collected at preoperative, 6-, 12-week, 6-month, 1-, and 2-year time points. Mean PROMs were compared using the Student t-test for independent samples. MCID attainment was determined using established values in the literature; achievement rates by grouping were compared using chi square analysis.Results:One hundred seventy-one patients were included, 121 MIS TLIF and 50 ALIF. No demographic differences were observed. Mean surgical times were 139.7 minutes (MIS TLIF) and 165.5 minutes (ALIF) (P < 0.001). No other perioperative differences were observed. Mean estimated blood loss values were 63.8 mL (MIS TLIF) and 73.7 mL (ALIF). Mean postoperative lengths of stay were 43.9 hours (MIS TLIF) and 42.5 hours (ALIF). Mean PROMs did not markedly differ among groups at any time point. MCID attainment was markedly higher among MIS TLIF patients for the Oswestry Disability Index at 6 weeks (P = 0.046) and 12 weeks (P = 0.007), Patient-Reported Outcomes Measurement Information System Physical Function at 12 weeks (P = 0.015), and VAS leg at 6 weeks (P = 0.031) and 12 weeks (P = 0.045). No other notable differences were observed among MCID achievement by grouping.Discussion:While single-level ALIF demonstrated markedly higher surgical times, other perioperative characteristics and PROMs were comparable among ALIF and MIS TLIF patients. Although MCID achievement rates were generally lower for disability and leg pain among ALIF patients, significance was not reached at 6 months, 1 year, or during the overall postoperative period after fusion.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 44%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Patel

Jacob

Pawlowski

et al. 2022

J Am Acad Orthop Surg

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“…The biomechanical significance of L5–S1 demands a strong effort in sagittal restoration, and the 2 surgical techniques most commonly used to achieve this are the TLIF and the anterior lumbar interbody fusion (ALIF), both of which have demonstrated successful fusion induction [ 83 ]. A recent study [ 84 ] by our team comparing MIS-TLIF to ALIF at L5–S1 discovered that ALIF patients on average experienced more favorable postoperative clinical outcomes in physical function, back pain, and leg pain, as well as significantly fewer incidences of postoperative fever. The ALIF is widely considered to be particularly suitable for lordosis restoration at L5–S1 [ 85 ], due to its increased and direct vertebral access window, allowing for implantation of a larger interbody cage.…”

Section: In the Present: Characterizing The Mis-tlifmentioning

confidence: 99%

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2022

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The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

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L5-S1 Pseudoarthrosis Rate with ALIF Versus TLIF in Adult Spinal Deformity Surgeries: A Retrospective Analysis of 100 Patients

et al. 2023

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Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Anterior Lumbar Interbody Fusion with Posterior Instrumentation at L5/S1

Cited by 8 publications

References 35 publications

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion for the Surgical Treatment of Isthmic Spondylolisthesis

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

L5-S1 Pseudoarthrosis Rate with ALIF Versus TLIF in Adult Spinal Deformity Surgeries: A Retrospective Analysis of 100 Patients

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