[Transforaminal lumbar interbody fusion: goals of the minimal invasive approach]. / Arthrodèses transforaminales: intérêts de l'abord minimal invasif.

BACKGROUND AND PURPOSE: Transforaminal lumbar interbody fusion (TLIF) is an effective technique, which can achieve a fusion rate of up to 90%. The minimally invasive approach has become increasingly popular because it is able to minimize iatrogenic soft tissue and muscle injury. Although the minimally invasive TLIF technique has gained popularity, its effectiveness compared with open TLIF has yet to be established. The authors prospectively compared the outcomes of patients who underwent mini-open TLIF with patients who underwent open TLIF. METHODS: Between 2007 and 2008, 50 patients underwent TLIF for grade 1 spondylolisthesis; 25 mini-open TLIF and 25 open TLIF. The mean age in each group was 48years, and there was no statistically significant difference between the groups. Data were collected perioperatively. Pain and functional disability were measured using a visual analogue scale (VAS) and the Oswestry disability index (ODI) at 3months, 6months, 1year and 2years. In addition, foraminal and disc height were measured at the same intervals and the fusion was evaluated at 1year on CT-scan. Soft tissue damage was evaluated by measuring the serum myoglobin and creatine phosphokinase activity. RESULTS: The mean VAS improved from 7 to 2.8 and the ODI decreased from 30/50 to 15/50 and fusion rate at 1 year was 98%. There was no statistical difference for the clinical and radiological outcomes between the groups. The mean operative time was 186min for the open group, 170min for the mini-open group (P<0.05) and the mean blood loss was 486mL for the open group and 148mL for the mini-open group (P<0.01). CONCLUSION: The mini-open TLIF procedure for symptomatic low grade spondylolisthesis is an effective option which achieves similar clinical and radiological outcomes and reduces perioperative morbidity as well as soft tissue damage.

Transforaminal lumbar interbody fusion: comparison between open and mini-open approaches with two years follow-up.

BACKGROUND: Transforaminal lumbar interbody fusion (TLIF) is an efficient technique which can achieve a fusion rate of up to 90%. Minimally invasive approaches have become increasingly popular because they appear to minimize iatrogenic soft tissue and muscle injury. As minimally invasive TLIF gains popularity, its effectiveness compared with open TLIF has yet to be established. OBJECTIVE: A retrospective study was performed with the aim to compare long-term outcomes of patients who underwent mini-open TLIF with those who underwent open TLIF. METHODS: This is a retrospective review of prospectively collected data. Between 2005 and 2008, 100 patients underwent TLIF for low-grade spondylolisthesis or degenerative disc disease; 60 underwent open TLIF and 40 underwent mini-open TLIF. The mean age in each group was 48 years, and there were no statistically significant differences between the groups. Data were collected perioperatively. Pain and functional disability were measured using visual analogue scale (VAS) and Oswestry disability index (ODI) at 3 months, 6 months, 1 year, and 2 years. In addition, the fusion was evaluated at 1 year on a computerized tomography (CT) scan. RESULTS: The mean VAS improved from 7.3 to 3.8 for back pain and from 7 to 2.7 for leg pain and the ODI decreased from 60 to 30% at 2 years postoperatively. The fusion rate at 1 year was 98%. There were no statistical differences for the clinical and radiological outcomes between the groups. The mean operative time was 186 minutes in the open group and 170 minutes in the mini-open group (p < 0.05) and the mean blood loss was 486 mL in the open group and 148 mL in the mini-open group (p < 0.01). CONCLUSION: The mini-open TLIF for symptomatic low-grade spondylolisthesis and degenerative disc disease is an effective option that achieves the same clinical and radiological outcomes at a minimum 2-year follow-up and reduces perioperative morbidity.