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Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve

  • Original Article - Spine degenerative
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Fábia Silva, Pedro Santos Silva, Rui Vaz & Paulo Pereira

  2. Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal

    Pedro Santos Silva, Rui Vaz & Paulo Pereira

  3. Neurosciences Center CUF, Porto, Portugal

    Rui Vaz & Paulo Pereira

Authors
  1. Fábia Silva
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  2. Pedro Santos Silva
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  3. Rui Vaz
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  4. Paulo Pereira
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Corresponding author

Correspondence to Fábia Silva.

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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.

Ethical approval

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.

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This article is part of the Topical Collection on Spine degenerative

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Silva, F., Silva, P.S., Vaz, R. et al. Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve. Acta Neurochir 161, 2415–2420 (2019). https://doi.org/10.1007/s00701-019-04079-w

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  • DOI: https://doi.org/10.1007/s00701-019-04079-w

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