A Retrospective Analysis of Superior Facet Joint Violation Between Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion and its Relation to Adjacent Segment Disease

Study Design: Retrospective, single institution, multisurgeon case control series. Objective: To determine whether there are differences in reoperation rates or outcomes for patients undergoing 2-level posterolateral fusion (PLF) augmented by a transforaminal lumbar interbody fusion (TLIF) at only one of the levels or at both. Methods: A total of 416 patients were identified who underwent 2-level PLF with a TLIF at either one of those levels (n = 183) or at both (n = 233) with greater than 1-year follow-up. Demographic, surgical, radiographic, and clinical data was reviewed for each patient. These included age, sex, race, body mass index, smoking status, Charleston Comorbidity Index, operative time, estimated blood loss, length of stay, and patient-reported outcome measures. Results: Each cohort underwent 24 reoperations. Although the number of overall reoperations was not significantly different ( P > .05), among the reoperation types, there were significantly more reoperations for adjacent segment disease in the 2-level group compared to the 1-level group (19 vs 12, P = .04). There was no difference in reoperation for pseudarthrosis between the groups ( P > .05). Although both groups experienced significant improvements in Oswestry Disability Index ( P < .001) and Short Form–12 health questionnaire ( P < .001), there were no differences between improvements for 1- versus 2-level cohorts. Conclusions: For patients undergoing 2-level PLF in the setting of a TLIF, using a TLIF at one versus both levels does not seem to influence reoperation rates or outcomes. However, reoperation rates for adjacent segment disease are increased in the setting of a 2-level PLF augmented by a 2-level TLIF.

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Benefit of Transforaminal Lumbar Interbody Fusion vs Posterolateral Spinal Fusion in Lumbar Spine Disorders

Neurosurgery ◽

10.1227/neu.0000000000001118 ◽

2015 ◽

Vol 79 (3) ◽

pp. 397-405 ◽

Cited By ~ 15

Author(s):

Steven D. Glassman ◽

Leah Y. Carreon ◽

Zoher Ghogawala ◽

Kevin T. Foley ◽

Matthew J. McGirt ◽

...

Keyword(s):

Spinal Stenosis ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Posterolateral Spinal Fusion ◽

Room Time ◽

Operating Room Time

Abstract BACKGROUND: Despite increasing use and potential benefits of transforaminal lumbar interbody fusion (TLIF) compared with posterolateral spinal fusion (PSF), previous studies have not documented improved clinical outcomes with TLIF vs PSF. OBJECTIVE: To compare the outcomes of TLIF with PSF in patients with spondylolisthesis, spinal stenosis, and adjacent level disease. METHODS: The National Neurosurgical Quality and Outcomes Database was queried for patients who had a lumbar fusion. Eighty-five percent (1722) of enrolled cases had 12-month follow-up data. There were 306 PSF patients and 1230 TLIF patients. PSF cases within each diagnostic subgroup were propensity-matched to patients who had TLIF. Sufficient propensity-matched controls were available for patients with spondylolisthesis (109), spinal stenosis (63), and adjacent segment disease (47). RESULTS: Operating room time, estimated blood loss, and length of stay were similar between PSF and TLIF in all 3 propensity-matched groups. In the spondylolisthesis group, there was a greater improvement in Oswestry Disability Index (ODI) with TLIF vs PSF at 3 months (19.4 vs 26.0, P =.009), 12 months (20.8 vs 29.3, P =.001), and in percentage reaching minimal clinically important difference at 12 months (80% vs 62%, P =.007). There were no differences in ODI improvement between PSF and TLIF in the stenosis or adjacent segment disease groups. CONCLUSION: TLIF generated more favorable ODI outcomes than PSF for patients with spondylolisthesis, but not for patients with spinal stenosis or adjacent segment disease. There was also equivalence in operating room time and estimated blood loss between TLIF and PSF, potentially altering the long-standing assumption that PSF is a simpler procedure.

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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

Asian Spine Journal ◽

10.4184/asj.2017.11.2.204 ◽

2017 ◽

Vol 11 (2) ◽

pp. 204-212 ◽

Cited By ~ 8

Author(s):

Hamid Rahmatullah Bin Abd Razak ◽

Priyesh Dhoke ◽

Kae-Sian Tay ◽

William Yeo ◽

Wai-Mun Yue

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Short Form ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Single Level ◽

Sf 36 ◽

Cage Subsidence ◽

The Mean

<sec><title>Study Design</title>Retrospective review of prospective registry data.</sec><sec><title>Purpose</title>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.</sec><sec><title>Overview of Literature</title>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.</sec><sec><title>Methods</title>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.</sec><sec><title>Results</title>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 (<italic>p</italic><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.</sec><sec><title>Conclusions</title>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.</sec>

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Instrumentation-related complications of lumbar degenerative disc diseases treated by minimally invasive transforaminal lumbar interbody fusion

Brain Science Advances ◽

10.26599/bsa.2019.9050019 ◽

2019 ◽

Vol 5 (3) ◽

pp. 213-219 ◽

Cited By ~ 2

Author(s):

Xinyu Yang ◽

Xinyu Liu

Keyword(s):

Minimally Invasive ◽

Neurological Deficit ◽

Interbody Fusion ◽

Facet Joint ◽

Surgical Techniques ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Degenerative Disc ◽

Percutaneous Pedicle Screw ◽

Superior Level

Objective: To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases (LDD) who underwent minimally invasive transforaminal lumbar interbody fusion (MIS- TLIF) and to discuss the potential strategy for the control of these complications. Methods: A total of 87 patients with LDD were treated with the MIS-TLIF procedure. Complications, including malposition or breakage of guide pin, percutaneous pedicle screw (PPS) or cages, neurological deficit, and superior-level facet joint violations, were determined during and after the surgery. Computed tomography (CT) was used to evaluate the PPS accuracy and the superior-level facet joint violations. Results: A total of 386 PPSs were used. During the surgery, 3 (0.8%) guide pin and 1 (0.3%) PPS perforated the anterior wall of the vertebral body, respectively. One (0.3%) PPS was pulled out during the reduction of slip. Malposition of the cages occurred in 6 (1.6%) PPSs. These were all adjusted accordingly during the surgery. All the patients received > 2 years of follow-up. No loosening or breakage of PPS and cage was observed, but CT showed 27 (7.0%) PPSs misplaced. No neurological deficit related to misplaced PPS was observed. The total facet joint violation (FJV) rate was 36.2%, with grade 2 and grade 3 violations is 21 (12.1%) and 6 (3.4%), respectively. Conclusion: MIS-TLIF has similar instrumentation-related complications with open TLIF. Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.

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