Long-Term Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-Year Follow-up Results

Abstract

Background Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years. Methods Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system. Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI). Results The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients ( P = 0.009, P = 0.040). Conclusion MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.

SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis

“…Nonetheless, this review was not able to assess long-term complication and reoperation rates, because none of the included studies reported long-term data. It is important to note that fusion has specific long-term risks, including pseudarthrosis, adjacent segment disease, hardware-related complications, and metallic wear related complications, while patients treated with endoscopic foraminotomy may require fusion surgery in the long-term ( 64 , 65 ). Furthermore, the cost of fusion surgery has increased over recent years, with 50% of the global cost being due to implants ( 66 ).…”

Biomechanical Comparison of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases after Primary Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis

“…Posterior spinal elements and facet joint capsules are not disrupted through an anterior or lateral approach 36,37 . Furthermore, most ASD occurs proximal to this location and thus would involve revision surgery at the mid or high lumbar segments 6,7 . Therefore, anterior and lateral approaches are more particularly suited for treating lumbar ASD since the majority of primary lumbar fusions occur at the L3–S1 level.…”

“…According to previous study, ASD is more likely to occur in the upper segment of the original surgery. 6 , 7 Therefore, revision surgical models of ALIF, LLIF, and TLIF at L3‐L4 segment were conducted, respectively. To simulate the revision surgical model of L3‐L4 TLIF (Fig.…”

“…In addition, ASD is more likely to occur in the upper segment of the original surgery. 6,7 Revision surgery was necessary for symptomatic ASD to fix the affected segment. [8][9][10] For revision of TLIF, the second surgery can be performed using a variety of approaches, such as posterior, direct anterior, or lateral.…”

“…The mean time between index and revision surgery was 26.2 months. In addition, ASD is more likely to occur in the upper segment of the original surgery 6,7 …”