Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion
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Prospective observational cohort study.
Comparison of clinical and radiological outcomes of single-level open versus minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) at 6 months and 2-year follow-up.
Summary of background data
There is recognition that more data are required to ascertain the benefits and risks of MIS vis-a-vis open TLIF. This study aims to report on one of the largest currently available series comparing the clinical and radiological outcomes of the two procedures with a minimum follow-up of 2 years.
From January 2002 to March 2008, 144 single-level open and MIS TLIF were performed at our centre, with 72 patients in each group. Clinical outcomes were based on patient-reported outcome measures recorded at the Orthopaedic Diagnostic Centre by independent assessors before surgery, at 6 months and 2 years post-operatively. These were visual analogue scores (VAS) for back and leg pain, Oswestry disability index (ODI), short form-36 (SF-36), North American Spine Society (NASS) scores for neurogenic symptoms, returning to full function, and patient rating of the overall result of surgery. Radiological fusion based on the Bridwell grading system was also assessed at 6 months and 2 years post-operatively by independent assessors.
In terms of demographics, the two groups were similar in terms of patient sample size, age, gender, body mass index (BMI), spinal levels operated, and all the clinical outcome measures (p > 0.05). Perioperative analysis revealed that MIS cases have comparable operative duration (open: 181.8 min, MIS: 166.4 min, p > 0.05), longer fluoroscopic time (open: 17.6 s, MIS: 49.0 s, p < 0.05), less intra-operative blood loss (open: 447.4 ml, MIS: 50.6 ml, p < 0.05) and no post-operative drainage (open: 528.9 ml, MIS: 0 ml, p < 0.05). MIS patients needed less morphine (open: 33.5 mg, MIS: 3.4 mg, p < 0.05) and were able to ambulate (open: 3.4 days, MIS: 1.2 days, p < 0.05) and be discharged from hospital earlier (open: 6.8 days, MIS: 3.2 days, p < 0.05).
At 6 months, clinical outcome analysis showed both groups improving significantly (>50.0 %) and similarly in terms of VAS, ODI, SF-36, return to full function and patient rating (p > 0.05). Radiological analysis showed similar grade 1 fusion rates (open: 52.2 %, MIS: 59.4 %, p > 0.05) with small percentage of patients developing asymptomatic cage migration (open: 8.7 %, MIS: 5.8 %, p > 0.05). One major complication (open: myocardial infarction, MIS: screw malpositioning requiring subsequent revision) and two minor complications in each group (open: pneumonia and post-surgery anemia, MIS: incidental durotomy and pneumonia) were noted.
At 2 years, continued improvements were observed in both groups as compared to the preoperative state (p > 0.05), with 50.8 % of open and 58 % of MIS TLIF patients returning to full function (p > 0.05). Almost all patients have Grade 1 fusion (open: 98.5 %, MIS: 97.0 %, p > 0.05) with minimal new cage migration (open: 1.4 %, MIS: 0 %, p > 0.05).
MIS TLIF is a safe option for lumbar fusion, and when compared to open TLIF, has similar operative duration, good clinical and radiological outcomes, with additional significant benefits of less perioperative blood loss and pain, earlier rehabilitation, and a shorter hospitalization.
- Herkowitz, HN, Sidhu, KS (1995) Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations. J Am Acad Orthop Surg 3: pp. 123-135
- Stonecipher, T, Wright, S (1989) Posterior lumbar interbody fusion with facet screw fixation. Spine 14: pp. 468-471 CrossRef
- Fraser, RD (1995) Interbody, posterior, and combined lumbar fusions. Spine 20: pp. S167-S177 CrossRef
- Fritzell, P, Hägg, O, Wessberg, P (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27: pp. 1131-1141 CrossRef
- Kuslich, SD, Ulstrom, CL, Griffith, SL (1998) The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine 23: pp. 1267-1279 CrossRef
- Cloward, RB (1953) The treatment of ruptured intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10: pp. 154-168 CrossRef
- Hodgson, AR, Stock, FE (1956) Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44: pp. 266-275 CrossRef
- Moskowitz, A (2002) Transforaminal lumbar interbody fusion. Orthop Clin North Am 33: pp. 359-366 CrossRef
- Harms, JG, Jeszenszky, D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6: pp. 88-99
- Rosenberg, WS, Mummaneni, PV (2001) Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 48: pp. 569-575 CrossRef
- Lowe, TG, Tahernia, AD, O’Brien, MF (2002) Unilateral trans-foraminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15: pp. 31-38 CrossRef
- Gejo, R, Matsui, H, Kawaguchi, Y (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24: pp. 1023-1028 CrossRef
- Rantanen, J, Hurme, M, Falck, B (1993) The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine 18: pp. 568-574 CrossRef
- Sihvonen, T, Herno, A, Paljiarvi, L (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18: pp. 575-581 CrossRef
- Styf, JR, Willen, J (1998) The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine 23: pp. 354-358 CrossRef
- Foley, KT, Holly, LT, Schwender, JD (2003) Minimally invasive lumbar fusion. Spine 15: pp. 26-35
- Schwender, JD, Holly, LT, Rouben, DP (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18: pp. S1-S6 CrossRef
- Peng, CW, Yue, WM, Poh, SY (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 34: pp. 1385-1389 CrossRef
- Villavicencio, AT, Burneikiene, S, Roeca, CM (2010) Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 31: pp. 12
- Wu, RH, Fraser, JF, Härtl, R (2010) Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine 35: pp. 2273-2281 CrossRef
- Shunwu, F, Xing, Z, Fengdong, Z (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35: pp. 1615-1620 CrossRef
- Whitecloud, TS, Roesch, WW, Ricciardi, JE (2001) Transforaminal interbody fusion versus anterior-posterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord 14: pp. 100-103 CrossRef
- Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion
European Spine Journal
Volume 21, Issue 11 , pp 2265-2270
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