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European Spine Journal

, Volume 21, Issue 11, pp 2265–2270 | Cite as

Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion

  • Kong Hwee Lee
  • Wai Mun Yue
  • William Yeo
  • Henry Soeharno
  • Seang Beng Tan
Original Article

Abstract

Study design

Prospective observational cohort study.

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Lumbar fusion Open Minimally invasive Clinical outcomes 

Notes

Acknowledgments

This study has been IRB approved by Singhealth Singapore.

Conflict of interest

Wai Mun Yue: Medtronics (Consultant, Fellowship support); Depuy (Consultant); Synthes (Consultant, Fellowship support).

References

  1. 1.
    Herkowitz HN, Sidhu KS (1995) Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations. J Am Acad Orthop Surg 3:123–135PubMedGoogle Scholar
  2. 2.
    Stonecipher T, Wright S (1989) Posterior lumbar interbody fusion with facet screw fixation. Spine 14:468–471PubMedCrossRefGoogle Scholar
  3. 3.
    Fraser RD (1995) Interbody, posterior, and combined lumbar fusions. Spine 20:S167–S177CrossRefGoogle Scholar
  4. 4.
    Fritzell P, Hägg O, Wessberg P et al (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 27:1131–1141PubMedCrossRefGoogle Scholar
  5. 5.
    Kuslich SD, Ulstrom CL, Griffith SL et al (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 23:1267–1279PubMedCrossRefGoogle Scholar
  6. 6.
    Cloward RB (1953) The treatment of ruptured intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10:154–168PubMedCrossRefGoogle Scholar
  7. 7.
    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 44:266–275PubMedCrossRefGoogle Scholar
  8. 8.
    Moskowitz A (2002) Transforaminal lumbar interbody fusion. Orthop Clin North Am 33:359–366PubMedCrossRefGoogle Scholar
  9. 9.
    Harms JG, Jeszenszky D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–99Google Scholar
  10. 10.
    Rosenberg WS, Mummaneni PV (2001) Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 48:569–575PubMedCrossRefGoogle Scholar
  11. 11.
    Lowe TG, Tahernia AD, O’Brien MF et al (2002) Unilateral trans-foraminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31–38PubMedCrossRefGoogle Scholar
  12. 12.
    Gejo R, Matsui H, Kawaguchi Y et al (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028PubMedCrossRefGoogle Scholar
  13. 13.
    Rantanen J, Hurme M, Falck B et al (1993) The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine 18:568–574PubMedCrossRefGoogle Scholar
  14. 14.
    Sihvonen T, Herno A, Paljiarvi L et al (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581PubMedCrossRefGoogle Scholar
  15. 15.
    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 23:354–358PubMedCrossRefGoogle Scholar
  16. 16.
    Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 15(suppl):26–35Google Scholar
  17. 17.
    Schwender JD, Holly LT, Rouben DP et al (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18:S1–S6PubMedCrossRefGoogle Scholar
  18. 18.
    Peng CW, Yue WM, Poh SY et al (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 34:1385–1389PubMedCrossRefGoogle Scholar
  19. 19.
    Villavicencio AT, Burneikiene S, Roeca CM et al (2010) Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 31(1):12Google Scholar
  20. 20.
    Wu RH, Fraser JF, Härtl R (2010) Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine 35:2273–2281PubMedCrossRefGoogle Scholar
  21. 21.
    Shunwu F, Xing Z, Fengdong Z et al (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620PubMedCrossRefGoogle Scholar
  22. 22.
    Whitecloud TS III, Roesch WW, Ricciardi JE (2001) Transforaminal interbody fusion versus anterior-posterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord 14:100–103PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Kong Hwee Lee
    • 1
  • Wai Mun Yue
    • 1
  • William Yeo
    • 1
  • Henry Soeharno
    • 1
  • Seang Beng Tan
    • 1
  1. 1.Department of Orthopaedic SurgerySingapore General HospitalSingaporeRepublic of Singapore

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