Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis

2021 ◽  
pp. 1-12
Author(s):  
Jonathan Huang ◽  
Erik E. Rabin ◽  
Geoffrey P. Stricsek ◽  
Kevin N. Swong
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Minor Complication ◽  
Patient Reported

OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF. METHODS The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies—of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated. RESULTS Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07–4.34) and minor (OR 2.20, 95% CI 1.22–3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03–0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13–0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (−30.70, 95% CI −41.84 to −19.55), VAS-BP (−3.87, 95% CI −4.97 to −2.77), and VAS-LP (−5.11, 95% CI −6.69 to −3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80–0.90). CONCLUSIONS MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patient-reported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.

scholarly journals Intraoperative and perioperative complications in minimally invasive transforaminal lumbar interbody fusion: a review of 513 patients

2015 ◽  
Vol 22 (5) ◽  
pp. 487-495 ◽  
Author(s):  
Albert P. Wong ◽  
Zachary A. Smith ◽  
Alexander T. Nixon ◽  
Cort D. Lawton ◽  
Nader S. Dahdaleh ◽  
...  
Keyword(s):  
Complication Rate ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Lumbar Degenerative Disc Disease ◽  
Significant Difference ◽  
Perioperative Complication

OBJECT Transforaminal lumbar interbody fusion (TLIF) has become one of the preferred procedures for circumferential fusion in the lumbar spine. Over the last decade, advances in surgical techniques have enabled surgeons to perform the TLIF procedure through a minimally invasive approach (MI-TLIF). There are a few studies reported in the medical literature in which perioperative complication rates of MI-TLIF were evaluated; here, the authors present the largest cohort series to date. They analyzed intraoperative and perioperative complications in 513 consecutive MI-TLIF–treated patients with lumbar degenerative disc disease. METHODS The authors performed a retrospective review of prospectively collected data on 513 consecutive patients treated over a 10-year period for lumbar degenerative disc disease using MI-TLIF. All patients undergoing either a first-time or revision 1- or 2-level MI-TLIF procedure were included in the study. Demographic, intraoperative, and perioperative data were collected and analyzed using bivariate analyses (Student t-test, analysis of variance, odds ratio, chi-square test) and multivariate analyses (logistic regression). RESULTS A total of 513 patients underwent an MI-TLIF procedure, and the perioperative complication rate was 15.6%. The incidence of durotomy was 5.1%, and the medical and surgical infection rates were 1.4% and 0.2%, respectively. A statistically significant increase in the infection rate was seen in revision MI-TLIF cases, and the same was found for the perioperative complication rate in multilevel MI-TLIF cases. Instrumentation failure occurred in 2.3% of the cases. After analysis, no statistically significant difference was seen in the rates of durotomy during revision and multilevel surgeries. There was no significant difference between the complication rates when stratified according to presenting diagnosis. CONCLUSIONS To the authors' knowledge, this is the largest study of perioperative complications in MI-TLIF in the literature. A total of 513 patients underwent MI-TLIF (perioperative complication rate 15.6%). The most common complication was a durotomy (5.1%), and there was only 1 surgical wound infection (0.2%). There were significantly more perioperative infections in revision MI-TLIF cases and more perioperative complications in multilevel MI-TLIF cases. The results of this study suggest that MI-TLIF has a similar or better perioperative complication profile than those documented in the literature for open-TLIF treatment of degenerative lumbar spine disease.

scholarly journals A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note

2019 ◽  
Vol 46 (4) ◽  
pp. E16 ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Winward Choy ◽  
Catherine A. Miller ◽  
Leslie C. Robinson ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Technical Note ◽  
Lumbar Interbody Fusion ◽  
Spinal Anesthetic ◽  
Novel Technique ◽  
Patient Reported ◽  
Multimodal Methods

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is associated with improved patient-reported outcomes in well-selected patients. Recently, some neurosurgeons have aimed to further improve outcomes by utilizing multimodal methods to avoid the use of general anesthesia. Here, the authors report on the use of a novel awake technique for MI-TLIF in two patients. They describe the successful use of liposomal bupivacaine in combination with a spinal anesthetic to allow for operative analgesia.

Curve Characteristics and Response of Sciatic and Olisthesis Scoliosis Following L5/S1 Transforaminal Lumbar Interbody Fusion in Adolescent Lumbar Spondylolisthesis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Chang-zhi Du ◽  
Ze-zhang Zhu ◽  
Yu Wang ◽  
Song Li ◽  
Liang Xu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Reduction Rate ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Coronal Imbalance ◽  
Patient Reported ◽  
Lumbosacral Spondylolisthesis ◽  
Lumbar Spondylolisthesis

Abstract BACKGROUND Lumbosacral spondylolisthesis-induced scoliosis is a rare clinical entity. Sagittal reconstruction and the coronal curve evolution after surgery for spondylolisthesis have not been investigated in depth. OBJECTIVE To compare the curve characteristics between sciatic scoliosis and olisthetic scoliosis and to further investigate the effects of lumbosacral transforaminal lumbar interbody fusion (TLIF) on scoliosis evolution. METHODS Adolescents with sciatic scoliosis group (SS group) or olisthetic scoliosis group (OS group) who underwent L5/S1 TLIF from 2010 to 2017 and were followed up for at least 2 yr were retrospectively reviewed. Radiographic parameters and patient-reported outcomes were evaluated. RESULTS There were 20 patients in the SS group (M/F: 8/12; age: 15.6 ± 2.2 yr) and 16 in the OS group (M/F: 6/10; age: 16.8 ± 2.5 yr). Both groups had similar preoperative Cobb angles, but more patients with coronal imbalance were observed in the SS group. Moreover, the OS group showed significantly larger L5 tilt and rotation. After surgery, the slip reduction rate of the SS group and OS group were 76.1% ± 12.4% and 79.4% ± 9.6%, respectively. Scoliosis resolution was observed in all patients in the SS group but only in 9 patients (56.2%) in the OS group. Patients with failed scoliosis resolution in the OS group were older and had a larger Cobb angle and L5 rotation compared with those with successful scoliosis resolution. CONCLUSION Lumbosacral TLIF can achieve satisfactory slip reduction and scoliosis resolution. Sciatic scoliosis often presents with coronal imbalance but also a preferable curve prognosis. A large Cobb angle and L5 rotation may hinder the resolution of olisthetic scoliosis.

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