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Postoperative clinical outcomes in patients undergoing MIS-TLIF versus LLIF for adjacent segment disease

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Abstract

Purpose

Few studies examine the clinical outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD). We aim to compare the postoperative clinical trajectory through patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) in patients undergoing MIS-TLIF versus LLIF for ASD.

Methods

Patients were stratified into two cohorts based on surgical technique for ASD: MIS-TLIF versus LLIF. PROMs of 12-Item Short Form Physical Component Score (SF-12 PCS), visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year time points. MCID attainment was calculated through comparison to established thresholds. Cohorts were compared through nonparametric inferential statistics.

Results

Fifty-four patients were identified, with 22 patients undergoing MIS-TLIF after propensity score matching. Patients undergoing MIS-TLIF for ASD demonstrated significant postoperative improvement up to 1-year VAS back, up to 1-year VAS leg, and 6-month through 1-year ODI (p ≤ 0.035, all). Patients undergoing LLIF demonstrated significant postoperative improvement in 6-month SF-12 PCS, 6-month through 1-year VAS back, 12-week through 6-month VAS leg, and 6-month to 1-year ODI (p ≤ 0.035, all). No significant differences were calculated between surgical techniques for PROMs or MCID achievement rates.

Conclusion

Patients undergoing either MIS-TLIF or LLIF for adjacent segment disease demonstrated significant postoperative improvement in pain and disability outcomes. Additionally, patients undergoing LLIF reported significant improvement in physical function. Both MIS-TLIF and LLIF are effective for the treatment of adjacent segment disease.

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Abbreviations

ASA:

American Society of Anesthesiologists

ASD:

Adjacent segment disease

BMI:

Body mass index

CCI:

Charlson comorbidity index

EBL:

Estimated blood loss

FEA:

Finite element analysis

HNP:

Herniated nucleus pulposus

JOA:

Japanese Orthopedic Association

LLIF:

Lateral lumbar interbody fusion

LL:

Lumbar lordosis

LOS:

Length of stay

MCID:

Minimum clinically important difference

MIS-TLIF:

Minimally invasive transforaminal lumbar interbody fusion

ODI:

Oswestry disability index

OLIF:

Oblique lateral interbody fusion

OME:

Oral morphine equivalents

ORA:

Office of Regulatory Affairs

PLIF:

Posterior lumbar interbody fusion

POD:

Postoperative day

PROMs:

Patient-reported outcome measures

SF-12 PCS:

12-Item Short Form Physical Component Score

SL:

Segmental lordosis

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA

    James W. Nie, Timothy J. Hartman, Eileen Zheng, Keith R. MacGregor, Omolabake O. Oyetayo, Dustin H. Massel, Arash J. Sayari & Kern Singh

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  1. James W. Nie
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  2. Timothy J. Hartman
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  3. Eileen Zheng
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  4. Keith R. MacGregor
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  5. Omolabake O. Oyetayo
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  6. Dustin H. Massel
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  7. Arash J. Sayari
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  8. Kern Singh
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Contributions

James W. Nie, BS: Conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, and writing—review and editing. Timothy J. Hartman, MD: Conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, and writing—review and editing. Eileen Zheng, BS: Project administration, data curation, investigation, and writing—review and editing. Keith R. MacGregor, BS: Project administration, data curation, investigation, and writing—review and editing. Omolabake O. Oyetayo, BS: Project administration, data curation, investigation, and writing—review and editing. Dustin H. Massel, MD: Conceptualization, methodology, supervision, resources, investigation, and writing—review and editing. Arash J. Sayari, MD: Conceptualization, methodology, supervision, resources, investigation, and writing—review and editing. Kern Singh, MD: Conceptualization, methodology, supervision, resources, investigation, and writing—review and editing.

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Correspondence to Kern Singh.

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Nie, J.W., Hartman, T.J., Zheng, E. et al. Postoperative clinical outcomes in patients undergoing MIS-TLIF versus LLIF for adjacent segment disease. Acta Neurochir 165, 1907–1914 (2023). https://doi.org/10.1007/s00701-023-05629-z

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  • DOI: https://doi.org/10.1007/s00701-023-05629-z

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