Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial

OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospective, randomized, single-blinded study was performed. A priori power analysis determined that 86 patients were needed to detect a difference of 1 point in the visual analog scale (VAS) pain score between groups. Ninety-three patients were randomized into depomedrol (DEPO) and no depomedrol (NODEPO) cohorts. Prior to surgical closure, DEPO patients received 1 ml depomedrol (80 mg) applied directly to the surgical site by using a Gelfoam carrier. NODEPO patients received 1 ml saline on the same Gelfoam carrier. Perioperative outcomes including acute postoperative pain and narcotic use were assessed for the duration of inpatient stay. Patient-reported outcomes (PROs) questionnaires including VAS back and leg pain scores, and Oswestry Disability Index (ODI) were administered preoperatively and at 6-week, 12-week, and 6-month follow-up. Outcomes for DEPO and NODEPO cohorts were compared using linear regression controlled for sex.RESULTSOf the 93 patients, 45 (48.4%) were randomized to DEPO and 48 (51.6%) to NODEPO. A greater percentage of DEPO patients were female (53.3% vs 27.1%, p = 0.010). There were no other significant differences in patient baseline characteristics. Similarly, operating time, estimated blood loss, and length of inpatient stay did not differ between cohorts. Patients in the DEPO cohort consumed fewer hourly narcotics on postoperative day 0 (5.3 vs 6.3 oral morphine equivalents/hour, p = 0.034). However, no differences in acute postoperative pain or total narcotics consumption were observed between groups. Preoperative VAS leg scores were statistically different between cohorts (p = 0.027). However, preoperative ODI and VAS back scores did not differ between groups. Additionally, DEPO and NODEPO groups experienced similar improvements in PROs at all postoperative time points.CONCLUSIONSLocal depomedrol use did not lead to decreases in acute postoperative pain or narcotics consumption after MIS TLIF. Additionally, local depomedrol was not associated with postoperative improvements in PROs. The findings of this randomized trial suggest that surgical and clinical outcomes following MIS TLIF may not be impacted by intraoperative application of depomedrol.Clinical trial registration no.: NCT03308084 (clinicaltrials.gov)

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Editorial: Perioperative outcomes and adverse events of minimally invasive surgery during transforaminal lumbar interbody fusion/posterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine15238 ◽

2016 ◽

Vol 24 (3) ◽

pp. 413-415

Author(s):

Robert F. Heary ◽

Michael G. Kaiser

Keyword(s):

Minimally Invasive Surgery ◽

Adverse Events ◽

Minimally Invasive ◽

Invasive Surgery ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Perioperative Outcomes ◽

Lumbar Interbody Fusion

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Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor

Journal of International Medical Research ◽

10.1177/0300060520920090 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092009

Author(s):

Yan Wang ◽

Yaqing Zhang ◽

Fanli Chong ◽

Yue Zhou ◽

Bo Huang

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Fatty Infiltration ◽

Transforaminal Lumbar Interbody Fusion ◽

Cerebrospinal Fluid Leakage ◽

Lumbar Interbody Fusion ◽

Multifidus Muscle ◽

Tubular Retractor ◽

Estimated Blood Loss

Objective To assess the feasibility and clinical results of microscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a novel tapered tubular retractor that preserves the multifidus. Method A total of 122 patients underwent MIS-TLIF using a tapered tubular retractor system from March 2016 to August 2017. Perioperative parameters and follow-up outcomes were reviewed. Results The follow-up period was 23.95 ± 1.43 months. The operative time averaged 130.48 ± 34.44 minutes. The estimated blood loss was 114.10 ± 96.70 mL. The mean time until ambulation was 16.33 ± 6.29 hours. The average visual analogue scale (leg/waist) and Oswestry Disability Index scores (preoperative to last follow-up) improved from 4.93 ± 2.68/3.74 ± 2.28 to 0.34 ± 0.77/0.64 ± 0.74 and from 59.09% ± 22.34 to 17.04% ± 8.49, respectively. At the last follow-up, 98.36% of the patients achieved solid fusion. Cerebrospinal fluid leakage occurred in two cases. The asymptote of the surgeon’s learning curve occurred at the 25th case. There were no significant differences between the preoperative qualitative and quantitative analyses of multifidus muscle fatty infiltration and those at the final follow-up. Conclusion MIS-TLIF can be performed safely and effectively using this tapered tubular retractor system, which helps preserve the multifidus.

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The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion

European Spine Journal ◽

10.1007/s00586-020-06344-4 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1304-1310

Author(s):

Nathaniel W. Jenkins ◽

James M. Parrish ◽

Benjamin C. Mayo ◽

Nadia M. Hrynewycz ◽

Thomas S. Brundage ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Pain ◽

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion

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303 Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Neurosurgery ◽

10.1093/neuros/nyx417.303 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 263-264

Author(s):

Anthony Michael DiGiorgio ◽

Gabriel Claudiu Tender

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Surgical Techniques ◽

Transforaminal Lumbar Interbody Fusion ◽

Secondary Outcome ◽

Low Grade ◽

Oral Antibiotic ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss

Abstract INTRODUCTION Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. However, prospective studies comparing S versus MI TLIF are rare. METHODS Patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis were enrolled, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Complications were also recorded. RESULTS >Forty patients were enrolled in each group. There was no crossover between groups. The age was 50.12 +/−11.09 years in the S TLIF group and 51.3 +/−9.36 years in the MI TLIF group. The mean operative time and estimated blood loss in the S versus MI TLIF group were 297 +/−101 versus 323 +/−85 minutes and 417 +/−211 versus 351 +/−198 ml, respectively. There were 4 transfusions in the S TLIF and 3 transfusions in the MI TLIF group. The patients were discharged after surgery at 4.12 +/−0.88 days for the S TLIF group and 1.92 +/−0.52 days for the MI TLIF group. The ODI improved from 37 +/−6 to 11 +/−6 in the S TLIF group (ODI difference: 26 +/−7) and from 38 +/−7 to 11 +/−6 in the MI TLIF group (ODI difference: 26 +/−8). In both groups, the fusion was considered solid (Grade I) in 36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were no reoperations for pseudarthrosis or any other postoperative complication. There were 2 superficial wound infections in the standard TLIF group, which resolved with oral antibiotic treatment alone. CONCLUSION The standard and minimally invasive TLIF in patients with symptomatic spondylolisthesis provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. Both surgical techniques yielded good results at 1 year.

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Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

BioMed Research International ◽

10.1155/2017/7236970 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Daniel Serban ◽

Niki Calina ◽

Gabriel Tender

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Randomized Study ◽

Transforaminal Lumbar Interbody Fusion ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss

Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. We enrolled patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Forty patients were enrolled in each group. The differences in mean operative time and estimated blood loss were not statistically significant between the two groups. The patients were discharged after surgery at 4.12 days for the S TLIF group and 1.92 days for the MI TLIF group. The ODI improvement was similar and statistically significant in both groups. The fusion was considered solid in 36 (90%) of patients at 1 year in both groups. In conclusion, the two techniques provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. This trial is registered with NCT03155789.

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Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis

10.21203/rs.3.rs-54610/v3 ◽

2020 ◽

Author(s):

Wenbin Hua ◽

Bingjin Wang ◽

Wencan Ke ◽

Xinghuo Wu ◽

Yukun Zhang ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Cauda Equina ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Lumbar Spinal ◽

Length Of Hospitalization

Abstract Background: The aim of the present study is to compare the clinical outcomes and postoperative complications of lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) to treat one-level lumbar spinal stenosis (LSS) without degenerative spondylolisthesis or deformity. Methods: A retrospective analysis of 112 consecutive patients of one-level LSS undergoing either LE-ULBD or MIS-TLIF was performed. Patient demographics, operation time, estimated blood loss, time to ambulation, length of hospitalization, intraoperative and postoperative complications were recorded. The visual analog scale (VAS) score for leg and back pain, the Oswestry Disability Index (ODI) score, and the Macnab criteria were used to evaluate the clinical outcomes. The healthcare cost was also recorded.Results: The operation time, estimated blood loss, time to ambulation and length of hospitalization of LE-ULBD group were shorter than MIS-TLIF group. The postoperative mean VAS and ODI scores decreased significantly in both groups. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 90.6% and 93.8% in the two groups. The mean VAS scores, ODI scores and outcomes of the modified Macnab criteria of both groups were of no significant difference. The healthcare cost of LE-ULBD group was lower than MIS-TLIF group. Two cases of intraoperative epineurium injury were observed in the LE-ULBD group. One case of cauda equina injury was observed in the LE-ULBD group. No nerve injury, dural injury or cauda equina syndrome was observed in MIS-TLIF group. However, one case with transient urinary retention, one case with pleural effusion, one case with incision infection and one case with implant dislodgement were observed in MIS-TLIF group. Conclusions: Both LE-ULBD and MIS-TLIF are safe and effective to treat one-level LSS without degenerative spondylolisthesis or deformity. LE-ULBD is a more minimally invasive option and of less economic burden compared with MIS-TLIF. Decompression plus instrumented fusion may be not necessary for one-level LSS without degenerative spondylolisthesis or deformity.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

Minimally Invasive Surgery ◽

10.1155/2012/657342 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Ali Habib ◽

Zachary A. Smith ◽

Cort D. Lawton ◽

Richard G. Fessler

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Modern Method ◽

Current Evidence ◽

Invasive Technique ◽

Published Data ◽

Lumbar Interbody Fusion ◽

Patient Reported ◽

Duration Of Surgery

This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques.Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications.Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications.Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

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Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion Surgery: An Analysis of Opioids, Nonopioid Analgesics, and Perioperative Characteristics

Global Spine Journal ◽

10.1177/2192568218822320 ◽

2019 ◽

Vol 9 (6) ◽

pp. 624-629 ◽

Cited By ~ 2

Author(s):

Aaron Hockley ◽

David Ge ◽

Dennis Vasquez-Montes ◽

Mohamed A. Moawad ◽

Peter Gust Passias ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Opioid Use ◽

Estimated Blood Loss ◽

History Of ◽

Nonopioid Analgesics

Study Design: Retrospective study of consecutive patients at a single institution.Objective: Examine the effect of minimally invasive surgery (MIS) versus open transforaminal lumbar interbody fusion (TLIF) surgery on long-term postoperative narcotic consumption. Objective: Examine the effect of minimally invasive versus open TLIF on short-term postoperative narcotic consumption. Methods: Differences between MIS and open TLIF, including inpatient opioid and nonopioid analgesic use, discharge opioid use, and postdischarge duration of narcotic usage were compared using appropriate statistical methods. Results: A total of 172 patients (109 open; 63 MIS) underwent primary TLIF. There was no difference in baseline characteristics. The MIS TLIF cohort had a significantly shorter operative time (223 vs 251 min, P = .006) and length of stay (2.7 vs 3.7 days, P < .001) as well as less estimated blood loss (184 vs 648 mL, P < .001). MIS TLIF had significantly less total inpatient opioid usage (167 vs 255 morphine milligram equivalent [MME], P = .006) and inpatient oxycodone usage (71 vs 105 mg, P = .049). Open TLIF cases required more ongoing opiate usage at 3-month follow-up (36% open vs 21% MIS, P = .041). A subanalysis found that patients who underwent an open TLIF with a history of preoperative opioid use are significantly more likely to remain on opioids at 6-week follow-up (87% vs 65%, P = .027), 3-month follow-up (63% vs 31%, P = .008), and 6-month follow-up (50% vs 21%, P = .018) compared with MIS TLIF. Conclusion: Patients undergoing MIS TLIF required less inpatient opioids and had a decreased incidence of opioid dependence at 3-month follow-up. Patients with preoperative opioid use undergoing MIS TLIF are less likely to require long-term opioids.

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Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health?

Global Spine Journal ◽

10.1177/2192568220912712 ◽

2020 ◽

pp. 219256822091271 ◽

Cited By ~ 1

Author(s):

Graham S. Goh ◽

Ming Han Lincoln Liow ◽

Wai-Mun Yue ◽

Seang-Beng Tan ◽

John Li-Tat Chen

Keyword(s):

Mental Health ◽

Minimally Invasive ◽

Interbody Fusion ◽

Short Form ◽

Transforaminal Lumbar Interbody Fusion ◽

Patient Reported Outcome Measures ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Sf 36 ◽

Patient Reported

Study design: This was a retrospective review of prospectively collected data. Objectives: Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups. Methods: Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years. Results: Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively ( P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months ( P = .353). The low MCS group had poorer satisfaction ( P = .022) and expectation fulfilment ( P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months ( P = .034), but the rates converged from 6 months onward. Conclusions: Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.

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Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part II: Consecutive Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa144 ◽

2020 ◽

Vol 19 (5) ◽

pp. 518-529

Author(s):

Jawad M Khalifeh ◽

Christopher F Dibble ◽

Priscilla Stecher ◽

Ian Dorward ◽

Ammar H Hawasli ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Rating Scale ◽

Case Series ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

The Mean

Abstract BACKGROUND Advances in operative techniques and instrumentation technology have evolved to maximize patient outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The transfacet MIS-TLIF is a modified approach to the standard MIS-TLIF that leverages a bony working corridor to access the disc space for discectomy and interbody device placement. OBJECTIVE To evaluate clinical and radiographic results following transfacet MIS-TLIF using an expandable interbody device. METHODS We performed a retrospective review of consecutive patients who underwent transfacet MIS-TLIF for degenerative lumbar spondylolisthesis. Patient-reported outcome measures for pain and disability were assessed. Sagittal lumbar segmental parameters and regional lumbopelvic parameters were assessed on upright lateral radiographs obtained preoperatively and during follow-up. RESULTS A total of 68 patients (61.8% male) underwent transfacet MIS-TLIF at 74 levels. The mean age was 63.4 yr and the mean follow-up 15.2 mo. Patients experienced significant short- and long-term postoperative improvements on the numeric rating scale for low back pain (–2.3/10) and Oswestry Disability Index (−12.0/50). Transfacet MIS-TLIF was associated with an immediate and sustained reduction of spondylolisthesis, and an increase in index-level disc height (+0.71 cm), foraminal height (+0.28 cm), and segmental lordosis (+6.83°). Patients with preoperative hypolordosis (<40°) experienced significant increases in segmental (+9.10°) and overall lumbar lordosis (+8.65°). Pelvic parameters were not significantly changed, regardless of preoperative alignment. Device subsidence was observed in 6/74 (8.1%) levels, and fusion in 50/53 (94.3%) levels after 12 mo. CONCLUSION Transfacet MIS-TLIF was associated with clinical improvements and restoration of radiographic sagittal segmental parameters. Regional alignment correction was observed among patients with hypolordosis at baseline.

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