Ten-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in Patients With Single-level: Lumbar Spondylolisthesis

Ji-Won Kwon, MD; Yung Park, MD; Byung Ho Lee, MD; So Ra Yoon, PhD; Joong-Won Ha, MD; Hyunkyo Kim, MD; Kyung-Soo Suk, MD; Seong-Hwan Moon, MD; Hak-Sun Kim, MD; Hwan-Mo Lee, MD

Disclosures

Spine. 2022;47(11):773-780. 

In This Article

Abstract and Introduction

Abstract

Study Design: A retrospective observational study.

Objective: This study investigated the clinical and radiological results of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (TLIF) in patients with single-level lumbar spondylolisthesis over a 10-year period.

Summary of Background Data: Few studies have compared 10-year follow-up outcomes between MI-TLIF and open TLIF.

Methods: We retrospectively collected the outcome data of patients with single-level lumbar spondylolisthesis who underwent TLIF procedures using an MI (n = 108) or open (n = 53) approach. Fifty-two (48%) and 31 (58%) patients in the MI-TLIF and open TLIF groups, respectively, completed the 10-year follow-up. A primary clinical outcome included the Oswestry Disability Index (ODI) as well as visual analog scale (VAS) scores for back and leg pain at baseline and at 2, 5, and 10 years postoperatively. The radiographic fusion rate and incidence of secondary surgery due to adjacent segment disease were assessed at 2, 5, and 10 years postoperatively.

Results: Intraoperative blood loss and length of hospitalization were significantly lower in the MI-TLIF group than in the open TLIF group. At 2 years postoperatively, the ODI and VAS scores for back and leg pain were significantly lower in the MI-TLIF group than in the open TLIF group. No significant differences were found in VAS scores for back and leg pain or ODI scores between the two groups at 10 years postoperatively. Radiographic fusion rates and prevalence of secondary surgery for adjacent segment disease were not significantly different between the groups at 10 years postoperatively.

Conclusion: Efficacy of MI-TLIF for patients with single-level lumbar spondylolisthesis is comparable to that of open TLIF over 10-years. However, MI-TLIF may have superior perioperative recovery and 2-year postoperative functional outcomes than open TLIF.

Level of Evidence: 3

Introduction

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the surgical treatment of degenerative lumbar disease minimizes nerve damage caused by soft tissue dissection and neural tissue retraction.[1–5] Posterior nerve decompression and intervertebral arthrodesis can be achieved using a tubular retractor combined with unilateral facetectomy. Augmentation for posterior fusion can also be achieved using percutaneous pedicle screws.[3,5,6] MI-TLIF has advantages, such as reduced intraoperative blood loss, earlier postoperative rehabilitation, shorter length of hospitalization, and reduced postoperative pain, over the traditional open method.[1,2,4–12] Several studies have reported favorable 5year postoperative results after MI-TLIF for the treatment of spondylolisthesis and other degenerative lumbar diseases. Therefore, this study aimed to compare clinical outcomes, such as Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, changes in the pattern of postoperative radiographic fusion, and postoperative complications (including the rate of adjacent segment disease ASD), between MI-TLIF and open TLIF in patients with singlelevel lumbar spondylolisthesis, with a minimum follow-up period of 10 years.

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