Peri-operative and 12-month outcomes in primary single level minimally invasive transforaminal lumbar interbody fusion versus conventional lumbar fusion

2017 ◽  
Vol 17 (3) ◽  
pp. S6
Author(s):  
Jagdeep Virdee ◽  
Adarsh Nadig ◽  
Joshi George ◽  
George Anagnostopoulos
2017 ◽  
Vol 11 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Priyesh Dhoke ◽  
Kae-Sian Tay ◽  
William Yeo ◽  
Wai-Mun Yue

<sec><title>Study Design</title><p>Retrospective review of prospective registry data.</p></sec><sec><title>Purpose</title><p>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.</p></sec><sec><title>Overview of Literature</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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/m<sup>2</sup>. 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 (<italic>p</italic>&lt;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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>


2005 ◽  
Vol 3 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Robert E. Isaacs ◽  
Vinod K. Podichetty ◽  
Paul Santiago ◽  
Faheem A. Sandhu ◽  
John Spears ◽  
...  

Object The authors have developed a novel technique for percutaneous fusion in which standard microendoscopic discectomy is modified. Based on data obtained in their cadaveric studies they considered that this minimally invasive interbody fusion could be safely implemented clinically. The authors describe their initial experience with a microendoscopic transforaminal lumbar interbody fusion (METLIF) technique, with regard to safety in the placement of percutaneous instrumentation, perioperative morbidity, and early postoperative results. Methods The METLIF procedure was performed unilaterally in 20 patients with single-level lumbar spondylolisthesis or pure mechanical back pain with endoscopic assistance, hemilaminectomy, unilateral facetectomy, and microdiscectomy. Two interbody grafts were placed via the lateral exposure of the disc space. Bilateral percutaneous pedicle screws were then inserted. Compared with patients who had undergone single-level posterior LIF at the same institutions, intraoperative blood loss, hospital length of stay (LOS), and postoperative narcotic agent use were significantly lower in the METLIF group. The mean LOS for the percutaneous fusion group was 3.4 days (5.1 days in those who underwent PLIF; p < 0.02). There have been no procedure-related complications in this series to date. Conclusions The METLIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, postoperative pain, total narcotic use, and the risk of transfusion.


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