Clinical Outcomes of Minimally Invasive Versus Open TLIF: A Propensity-Matched Cohort Study.

In this study, we compare intermediate-term outcomes in minimally invasive surgical transforaminal lumbar interbody fusion (MIS TLIF) to open TLIF. Sixty-four patients who underwent 1- to 2-level MIS TLIF with baseline, 1-, and 2-year outcome measures were identified. These were propensity-matched to a cohort of open TLIF patients based on age, body mass index, sex, smoking status, workers' compensation status, and preoperative outcome measures. At 1 year, both groups had similar improvements in pain and Short-Form 36 (SF-36) Physical Composite Summary (PCS), but the MIS TLIF group had a statistically significantly greater improvement in Oswestry Disability Index (ODI) compared with the open TLIF group. At 2 years, the MIS TLIF group had a statistically significantly greater improvement in pain and ODI compared with the open TLIF group, but no statistically significant difference in SF-36 PCS. Both MIS TLIF and open TLIF lead to significant improvements in clinical outcomes. At 1 year after surgery, MIS TLIF patients had greater improvements in ODI, and at 2 years after surgery, they had greater improvements in pain and ODI. This study showed that the perioperative advantages of MIS TLIF, such as less muscle dissection and faster recovery, continue to be beneficial 1 to 2 years after surgery.

Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up.

BACKGROUND CONTEXT: Both open and minimally invasive lumbar fusion surgeries (MIS) are used to treat patients with symptomatic degenerative spinal pathologies. Open lumbar fusion surgery studies have reported excellent short-term safety and long-term clinical outcomes. MIS has shown excellent safety and short-term clinical success, but there is very little information on its long-term clinical durability. PURPOSE: The purpose of this study was to document the long-term clinical durability and safety of patients treated with minimally invasive surgery--transforaminal lumbar interbody fusion (MIS TLIF). Secondary purposes were to evaluate the clinical outcomes of patients receiving fusion in 2 sequential lumbar disc segments (2-level) as compared with a single-level lumbar disc segment (1-level), and as an aside, to determine whether or not there were any differences in clinical outcomes in patients treated over the age of 60 years as compared with those under 60 years. STUDY DESIGN: This study was a retrospective review of prospective collected outcomes data. PATIENT SAMPLE: One hundred sixty-nine consecutive patients, with either isolated single-level or 2-level lumbar intervertebral segment pain manifested by back pain alone or back pain with leg pain associated with a primary diagnosis of degenerative spondylolisthesis, central herniated disc, central stenosis, Foraminal-lateral herniation of disc, Foraminal/lateral stenosis, or isolated degenerative disc or joint disease. OUTCOMES MEASURES: Hospital stay time postoperative, return to work time, Oswestry Disability Index (ODI), visual analog pain scores (VAS), pain medicine (narcotic) use, fusion status, and reoperation rate. METHODS: Patients treated with 1or 2-level MIS TLIF were evaluated based on clinical outcomes, reoperation rates, and fusion status out to an average of 49 months postoperative (range, 36 to 60 mo). Effect of the number of levels fused, patient age, and worker compensation status on outcome was also assessed. RESULTS: Average surgery time was 183 minutes, with no difference between older and younger patients. Hospital stay averaged 15 hours with a median return to work time of 8 weeks. Return to work for patients working before surgery was 97%. ODI improved 36% at the first follow-up and was improved 41% at 49 months postoperative (P < 0.001). Eighty-six percent of patients reached a 20% clinical improvement in ODI at the last follow-up. Every primary diagnostic group increased significantly over time (P < 0.001). VAS pain scores improved in a similar pattern as ODI (P < 0.001). Patients with 2-level fusions improved comparably in both ODI and VAS scores as 1-level fusion patients. Worker compensation patients improved in both ODI and pain scores, although a little less than nonworkers compensation patients. Neither smoking, nor obesity status impacted clinical outcomes. Narcotic use for spine related pain went from 100% to 31% 6 months postoperative. Fusion rates were 96% at the 1-year follow-up. When reviewing surgical revisions as a consequence of surgical technique, and omitting unanticipated adverse events, 99% of patients maintained a successful fusion at their last average follow-up. CONCLUSIONS: The results of this study support the long-term clinical effectiveness of MIS TLIF for varying diagnoses. These results suggest that those undergoing a 1-level or 2-level lumbar fusion improve equally, and that older patients do well with MIS surgery long term. Reoperation rates were acceptable, with excellent surgical durability at 49 months. The benefit of decompression was not assessed in this study, and future studies should assess its impact long term.

Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications.

The authors provide an overview of the minimally invasive transforaminal lumbar interbody fusion (TLIF) procedure including indications, technique, and complications. This novel technique is a method of achieving circumferential lumbar fusion using a unilateral dorsal approach. Minimally invasive TLIF uses a tubular retractor that is inserted via a muscle-dilating exposure, thereby minimizing the approach-related morbidity. This procedure is ideal for refractory mechanical low-back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The authors' clinical experience and review of the medical literature indicate that TLIF can be effectively and safely performed in a minimally invasive fashion.

Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results.

Forty-nine patients underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) from October 2001 to August 2002 (minimum 18-month follow-up). The diagnosis was degenerative disc disease with herniated nucleus pulposus (HNP) in 26, spondylolisthesis in 22, and a Chance-type seatbelt fracture in 1. The majority of cases (n = 45) were at L4-L5 or L5-S1. A paramedian, muscle-sparing approach was performed through a tubular retractor docked unilaterally on the facet joint. A total facetectomy was then conducted, exposing the disc space. Discectomy and endplate preparation were completed through the tube using customized surgical instruments. Structural support was achieved with allograft bone or interbody cages. Bone grafting was done with local autologous or allograft bone, augmented with recombinant human bone morphogenetic protein-2 in some cases. Bilateral percutaneous pedicle screw-rod placement was accomplished with the Sextant system. There were no conversions to open surgery. Operative time averaged 240 minutes. Estimated blood loss averaged 140 mL. Mean length of hospital stay was 1.9 days. All patients presenting with preoperative radiculopathy (n = 45) had resolution of symptoms postoperatively. Complications included two instances of screw malposition requiring screw repositioning and two cases of new radiculopathy postoperatively (one from graft dislodgement, the other from contralateral neuroforaminal stenosis). Narcotic use was discontinued 2-4 weeks postoperatively. Improvements in average Visual Analogue Pain Scale and Oswestry Disability Index (preoperative to last follow-up) scores were 7.2-2.1 and 46-14, respectively. At last follow-up, all patients had solid fusions by radiographic criteria. Results of this study indicate that minimally invasive TLIF is feasible and offers several potential advantages over traditional open techniques.