Abstract
Purpose
The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease.
Methods
We conducted a prospective cohort study of 82 patients, who underwent two-level minimally invasive or open transforaminal lumbar interbody fusion (TLIF) from March 2010 to December 2011. Forty-four patients underwent minimally invasive transforaminal lumbar interbody fusion (MITLIF) (group A) and 38 patients underwent the traditional open TLIF (group B). Demographic data and clinical characteristics were comparable between the two groups before surgery (p > 0.05). Peri-operative data, clinical and radiological outcomes between the two groups were compared.
Results
The mean follow-up period was 20.6 ± 4.5 months for group A and 20.0 ± 3.3 months for group B (p > 0.05). No significant difference existed in operating time between the two group (p > 0.05). X-ray exposure time was significantly longer for MITLIF compared to open cases. Intra-operative blood loss and duration of postoperatively hospital stay of group A were significantly superior to those of group B (p < 0.05). On postoperative day three, MITLIF patients had significantly less pain compared to patients with the open procedure. No statistical difference existed in pre-operative and latest VAS value of back pain (VAS-BP) and leg pain (VAS-LP), pre-operative and latest ODI between the two groups. The fusion rate of the two groups was similar (p < 0.05). Complications included small dural tear, superficial wound infection and overlong screws. When comparing the total complications, no significant difference existed between the groups (p > 0.05).
Conclusions
MITLIF offers several potential advantages including postoperative back pain and leg pain, intra-operative blood loss, transfusion and duration of hospital stay postoperatively in treating two-level lumbar degenerative disease. However, it required much more radiation exposure.
Similar content being viewed by others
References
Sethi A, Lee S, Vaidya R (2009) Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw. Eur Spine J 18:430–434
Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB (2012) Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21:2265–2270
Lowe TG, Tahernia AD, O'Brien MF, Smith DA (2002) Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31–38
Rosenberg WS, Mummaneni PV (2001) Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 48:569–574, discussion 574–575
Foley KT, Lefkowitz MA (2002) Advances in minimally invasive spine surgery. Clin Neurosurg 49:499–517
Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18:S1–6
Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 34:1385–1389
Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A (2010) Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 1:12
Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2010) Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 19:1780–1784
Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620
Kai Z, Wei S, Chang-Qing Z, Hua L, Wei D, You-Zhuan X, Xiao-Jiang S, Jie Z (2013) Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study. Int Orthop 2013 Aug 6. [Epub ahead of print]
Gu G, Zhang H, He S, Jia J, Fu Q, Zhou X (2013) Preoperative localization methods for minimally invasive surgery in lumbar spine: comparisons between a novel method and conventional methods. J Spinal Disord Tech 26:E277-277E280
Yucesoy K, Yuksel KZ, Baek S, Sonntag VK, Crawford NR (2008) Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease. J Neurosurg Spine 8:44–51
Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW Jr, Kuklo TR (2005) Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18:337–346
Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects. Spine 20:1410–1418
Harms J, Rolinger H (1982) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb 120:343–347
Blume HG (1985) Unilateral posterior lumbar interbody fusion: simplified dowel technique. Clin Orthop Relat Res 193:75–84
Harms JG, Jeszenszky D (1998) In Process Citation. Oper Orthop Traumatol 10:90–102
Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K (2006) Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 4:198–205
Branch CL Jr (1996) The case for posterior lumbar interbody fusion. Clin Neurosurg 43:252–267
DiPaola CP, Molinari RW (2008) Posterior lumbar interbody fusion. J Am Acad Orthop Surg 16:130–139
German JW, Foley KT (2005) Minimal access surgical techniques in the management of the painful lumbar motion segment. Spine 30:S52–59
Xiao Y, Li F, Chen Q (2010) Transforaminal lumbar interbody fusion with one cage and excised local bone. Arch Orthop Trauma Surg 130:591–597
Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028
Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581
Weber BR, Grob D, Dvorak J, Muntener M (1997) Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 22:1765–1772
Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33:1683–1688
Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28:S26–35
Min S, Hwang S (2009) Minimal invasive unilateral transforaminal lumbar interbody fusion by sublaminar decompression - comparison to bilateral approach. J Korean Orthop Assoc 44:7682
Min S, Lee D (2009) Minimally invasive transforaminal lumbar interbody fusion in patients with low grade spondylolisthesis - comparison of the unilateral and bilateral approaches. J Korean Orthop Assoc 44:429435
Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA (2009) Occupational health hazards in the interventional laboratory: time for a safer environment. Radiology 250:538–544
Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100:13761–13766
Thorne MC (2012) Regulating exposure of the lens of the eye to ionising radiations. J Radiol Prot 32:147–154
Acknowledgments
We thank Xia Zhang, a nurse in our hospital, for her excellent daily work in our surgery.
Disclosure
The authors declare that they have no competing interests. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
Guangfei Gu and Hailong Zhang contributed equally to this work.
Rights and permissions
About this article
Cite this article
Gu, G., Zhang, H., Fan, G. et al. Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. International Orthopaedics (SICOT) 38, 817–824 (2014). https://doi.org/10.1007/s00264-013-2169-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-013-2169-x