Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis

STUDY DESIGN: Retrospective review of prospective registry data. PURPOSE: To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis. OVERVIEW OF LITERATURE: MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion. METHODS: The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates. RESULTS: Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m². The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (p<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported. CONCLUSIONS: Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.

Revision total knee arthroplasty: causes and outcomes

<p><b>INTRODUCTION</b>Local data on revision total knee arthroplasty (TKA) are limited. This study aims to assess the causes and outcomes of revision TKA in a single institution, with a 2-year follow-up.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of case records of patients who underwent revision TKA in 2008 and 2009 in the authors' institution was performed. Outcome was assessed using SF-36, Oxford knee score and Knee Society Clinical Rating System preoperatively, at 6 months and at 2 years' follow-up.</p><p><b>RESULTS</b>Forty-one patients (41 knees) were included in the study. Indications for revision were aseptic loosening in 13 (31.7%), mechanical wear/component failure in 10 (24.4%), infection in 9 (22.0%), malalignment in 4 (9.8%), instability in 3 (7.3%), periprosthetic fracture in 1 (2.4%) and persistent stiffness in 1 (2.4%). Significant improvements were seen postoperatively in all 3 instruments used to evaluate clinical outcome. These improvements were seen at 6 months after surgery, and were maintained through the 2-year follow-up period. There were no significant changes in all scores between 6 months and 2 years follow-up. There was 100% survivorship of the implants with no postoperative complications requiring surgical intervention.</p><p><b>CONCLUSION</b>Indications for revision TKA locally are similar to those in other large centres. Revision total knee arthroplasty results in significantly improved function and quality of life for patients, which is maintained over a 2-year follow-up period. In our series, we obtained 100% implant survivorship.</p>