Clinical outcome and multifidus muscle changes of transforaminal lumbar interbody fusion: Minimally invasive procedure versus conventional open approach

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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S-line as Predictor of Clinical Outcome for Patients Undergone Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

10.21203/rs.3.rs-778819/v1 ◽

2021 ◽

Author(s):

Yilin Lu ◽

Jian Zhu ◽

Xi Luo ◽

Kaiqiang Sun ◽

Jingchuan Sun ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Lumbar Spinal

Abstract Background: Some have speculated that LSTV has an impact on lumbar curve. A retrospective study was conducted to evaluate S-line as predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.Methods: 126 patients undergoing transforaminal lumbar interbody fusion were enrolled. S-line stands for the connecting line between the highest points of the iliac crests on both sides. The patients were divided into two groups according to the position of S-line, S-line (-) group included patients whose S-line were between L4 and L5, and S-line (+) group included patients whose S-line is above or below this range, which were divided into two subgroups. Their pre-operative imaging data about sagittal alignment were collected, including lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT). Clinical outcomes were measured using Japanese Orthopaedic Association (JOA) scores, the Oswestry disability index (ODI), visual analog scale (VAS) before the surgery and postoperatively. The correlation of S-line and clinical outcomes, as well as sagittal alignment and clinical outcomes, were analyzed.Results: LL, SS, PI, PT and PI minus(-) LL of S-line (-) group were (45.39°±12.68°), (30.27°±10.55°), (43.32°±12.22°), (13.05°±6.52°), (-2.07°±8.20°), respectively, and those parameters of S-line (+) group were (40.29±14.92), (35.70°±14.09°), (52.59°±17.07°), (16.89°±8.24°), (12.30°±9.98°), respectively. Significant difference were seen in the above parameters between S-line (-) and S-line (+) group. For S-line (-) and S-line (+) group, post-operative JOA score were (22.39±2.12), (20.26±2.46), post-operative VAS were (2.07±0.88), (3.14±1.47), the post-operative ODI were (8.36±3.28), (11.82±3.32), the improvement rate is (0.61±0.13), (0.55±0.15), Significant differences of those parameters are seen between S-line (-) group and S-line (+) group.Conclusion: S-line is a reliable predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.

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Lumbar Alignment and Clinical Outcome after Single Level Asymmetrical Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis with Local Coronal Imbalance

Neurologia medico-chirurgica ◽

10.2176/nmc.st.2013-0394 ◽

2014 ◽

Vol 54 (9) ◽

pp. 691-697 ◽

Cited By ~ 7

Author(s):

Toshiyuki TAKAHASHI ◽

Junya HANAKITA ◽

Mizuki WATANABE ◽

Taigo KAWAOKA ◽

Noriyoshi TAKEBE ◽

...

Keyword(s):

Clinical Outcome ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Single Level ◽

Coronal Imbalance ◽

Lumbar Alignment

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Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in 1-Segment Lumbar Spondylolisthesis: A Prospective Randomised Pilot Study

10.21203/rs.3.rs-397849/v1 ◽

2021 ◽

Author(s):

You Lv ◽

Ming Chen ◽

Ru-Jie Qin ◽

Cheng Ma ◽

Qi-Rui Ding ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Bone Morphogenetic Protein 2 ◽

Lumbar Interbody Fusion ◽

Trial Registry ◽

Clinical Trial Registry ◽

Multifidus Muscle ◽

Lumbar Spondylolisthesis

Abstract BackgroundThere are currently several minimally invasive techniques for lumbar spine interbody fusion that have been shown to minimize surgical and perioperative morbidity. We aimed to evaluate the curative efficacy of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) by comparing perioperative characteristics and 1.5-year observational outcomes in 1-segment lumbar spondylolisthesis between the minimally invasive TLIF (MIS-TLIF) technique and the optimized Endo-TLIF technique. MethodsOne hundred and two patients treated by MIS-TLIF (48 cases) or Endo-TLIF (54 cases) were included from January 2017 to January 2019. Perioperative parameters and clinical outcomes were evaluated. Inflammatory biomarkers were measured for postoperative traumatic stress and muscle injury. Fusion rates were determined at 18 months after surgery by CT and the necessity of recombinant human bone morphogenetic protein-2 (rhBMP-2) application in Endo-TLIF was also observed. ResultsThe Endo-TLIF group had similar incision length, return to work time and rate (p>0.05). Blood loss, left bed time and analgesic ratio were significantly less in Endo-TLIF group (p<0.05). The Endo-TLIF group had a significantly longer operative and radiation exposure time compared with MIS-TLIF group (p<0.05). The CRP and ESR levels were lower in the Endo-TLIF group compared with the MIS-TLIF group (p<0.05). The VAS and ODI improved significantly in both groups after surgery. Significant decreases in low back VAS in the Endo-TLIF group were found at postoperative day 1 and 3 months after surgery (p<0.05). The fusion rate in the Endo-TLIF/rhBMP-2 group (75%) was lower than that in the MIS-TLIF group (95.8%)，but it was similar to that in the Endo-TLIF/rhBMP-2 group (90%).ConclusionsEndo-TLIF has comparable perioperative analysis and clinical outcomes in comparison to MIS-TLIF and manifests a greater improvement in less multifidus muscle damage, inflammation and faster patient recovery. Thus, Endo-TLIF should be considered as a feasible and effective technique for 1-segment lumbar spondylolisthesis patients.Trial registration: ChiCTR1800015197, 13 March 2018. Trial registry: Chinese Clinical Trial Registry.

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