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Clinical Orthopaedics and Related Research®

, Volume 472, Issue 6, pp 1813–1823 | Cite as

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

  • Yung ParkEmail author
  • Joong Won Ha
  • Yun Tae Lee
  • Na Young Sung
Symposium: Minimally Invasive Spine Surgery

Abstract

Background

Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported.

Questions/purposes

We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup.

Methods

We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003–2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve.

Results

At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve.

Conclusions

Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Keywords

Spondylolisthesis Oswestry Disability Index Transforaminal Lumbar Interbody Fusion Adjacent Segment Disease Oswestry Disability Index Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Ju-Hyung Yoo MD for his great support as a third adjudicating reviewer. We are also grateful to Manee Shim RN and Jihye Jung RN for their enormous assistance with the data collection.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Yung Park
    • 1
    Email author
  • Joong Won Ha
    • 1
  • Yun Tae Lee
    • 1
  • Na Young Sung
    • 1
  1. 1.Department of Orthopedic Surgery, National Health Insurance Service Ilsan HospitalYonsei University College of MedicineGoyang CityRepublic of Korea

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