Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve
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A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team’s initial learning period.
The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients’ demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment.
Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient’s order number (r = − 0.539, p = 0.002).
In our initial experience, MIDLIF showed to be effective in significantly improving the patients’ functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.
KeywordsMIDLIF Midline lumbar interbody fusion Minimally invasive spine surgery Lumbar arthrodesis Cortical bone trajectory screws Learning curve
Compliance with ethical standards
Conflict of interest
PP has an education and training and consultancy agreement with Medtronic Sofamor Danek, USA. FS, PSS, and RV certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Comissão de Ética para a Saúde do Centro Hospitalar Universitário de São João) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 3.Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales. Spine J 8(6):968–974CrossRefGoogle Scholar
- 6.Elmekaty M, Kotani Y, El Mehy E, Robinson Y, El Tantawy A, Sekiguchi I, Fujita R (2018) Clinical and radiological comparison between three different minimally invasive surgical fusion techniques for single-level lumbar isthmic and degenerative spondylolisthesis: Minimally invasive surgical posterolateral fusion versus minimally invasive surgical transforaminal lumbar interbody fusion versus midline lumbar fusion. Asian Spine J 12(5):870–879CrossRefGoogle Scholar
- 10.Lee CS, Eoh W, Chung SS, Lee SH, Kim ES, Kim MK (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 12(1)Google Scholar
- 16.Phillips JT (2017) Comparing mid lumbar interbody fusion (MIDLF) with traditional posterior lumbar interbody fusion (PLIF). Electronic Thesis And Dissertation Repository, 4541Google Scholar
- 20.Smith S, Weldring T (2013) Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Services Insights 61Google Scholar