Minimally invasive transforaminal lumbar interbody fusion

Jhala, Amit; Singh, Damandeep; Mistry,

doi:10.4103/0019-5413.144217

Cited by 13 publications

(14 citation statements)

References 16 publications

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“…For patients with symptomatic lumbar spondylolisthesis, conventional TLIF has been accepted as one of the options for surgical management. 9 In past decades many published series have demonstrated similar clinical outcomes with MI-TLIF, which has caused less collateral tissue damage and blood loss, required a shorter hospital stay, and yielded an earlier recovery than conventional TLIF. 9,10,33 There was also the emerging option of dynamic stabilization in the management of low-grade spondylolisthesis with satisfactory results.…”

Section: Discussionmentioning

confidence: 92%

“…9 In past decades many published series have demonstrated similar clinical outcomes with MI-TLIF, which has caused less collateral tissue damage and blood loss, required a shorter hospital stay, and yielded an earlier recovery than conventional TLIF. 9,10,33 There was also the emerging option of dynamic stabilization in the management of low-grade spondylolisthesis with satisfactory results. The surgical approach of dynamic stabilization involves more soft tissue dissection than percutaneous pedicle screw insertion, but its biomechanical alterations remain elusive.…”

Section: Discussionmentioning

confidence: 92%

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Radiological adjacent-segment degeneration in L4–5 spondylolisthesis: comparison between dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion

Kuo

Huang

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEPedicle screw–based dynamic stabilization has been an alternative to conventional lumbar fusion for the surgical management of low-grade spondylolisthesis. However, the true effect of dynamic stabilization on adjacent-segment degeneration (ASD) remains undetermined. Authors of this study aimed to investigate the incidence of ASD and to compare the clinical outcomes of dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).METHODSThe records of consecutive patients with Meyerding grade I degenerative spondylolisthesis who had undergone surgical management at L4–5 in the period from 2007 to 2014 were retrospectively reviewed. Patients were divided into two groups according to the surgery performed: Dynesys dynamic stabilization (DDS) group and MI-TLIF group. Pre- and postoperative radiological evaluations, including radiography, CT, and MRI studies, were compared. Adjacent discs were evaluated using 4 radiological parameters: instability (antero- or retrolisthesis), disc degeneration (Pfirrmann classification), endplate degeneration (Modic classification), and range of motion (ROM). Clinical outcomes, measured with the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association (JOA) scores, were also compared.RESULTSA total of 79 patients with L4–5 degenerative spondylolisthesis were included in the analysis. During a mean follow-up of 35.2 months (range 24–89 months), there were 56 patients in the DDS group and 23 in the MI-TLIF group. Prior to surgery, both groups were very similar in demographic, radiological, and clinical data. Postoperation, both groups had similarly significant improvement in clinical outcomes (VAS, ODI, and JOA scores) at each time point of evaluation. There was a lower chance of disc degeneration (Pfirrmann classification) of the adjacent discs in the DDS group than in the MI-TLIF group (17% vs 37%, p = 0.01). However, the DDS and MI-TLIF groups had similar rates of instability (15.2% vs 17.4%, respectively, p = 0.92) and endplate degeneration (1.8% vs 6.5%, p = 0.30) at the cranial (L3–4) and caudal (L5–S1) adjacent levels after surgery. The mean ROM in the cranial and caudal levels was also similar in the two groups. None of the patients required secondary surgery for any ASD (defined by radiological criteria).CONCLUSIONSThe clinical improvements after DDS were similar to those following MI-TLIF for L4–5 Meyerding grade I degenerative spondylolisthesis at 3 years postoperation. According to radiological evaluations, there was a lower chance of disc degeneration in the adjacent levels of the patients who had undergone DDS. However, other radiological signs of ASD, including instability, endplate degeneration, and ROM, were similar between the two groups. Although none of the patients in the present series required secondary surgery, a longer follow-up and a larger number of patients would be necessary to corroborate the protective effect of DDS against ASD.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Radiological adjacent-segment degeneration in L4–5 spondylolisthesis: comparison between dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion

Kuo

Huang

et al. 2018

Journal of Neurosurgery: Spine

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“…A number of series have demonstrated that MITLIF pro vided similar clinical and functional outcomes with less softtissue damage, decreased blood loss, reduced length of hospital stay, and earlier recovery than standard open TLIF. 11,12,28 In a retrospective study of 100 patients with lowgrade spondylolisthesis, there were no statistical dif ferences between 2 groups of patients who underwent open versus minimally invasive approaches with more than 4 years of followup. The clinical and radiological outcomes were similar, although longer operative time and more EBL were demonstrated in the group of patients who under went open TLIF.…”

Section: Discussionmentioning

confidence: 98%

“…11 During the last decade, MITLIF has been an emerging option. A number of series have demonstrated that MITLIF pro vided similar clinical and functional outcomes with less softtissue damage, decreased blood loss, reduced length of hospital stay, and earlier recovery than standard open TLIF.…”

Section: Discussionmentioning

confidence: 99%

Dynamic stabilization for L4–5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up

Kuo

Chang

et al. 2016

FOC

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OBJECTIVE In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4–5. METHODS This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4–5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery. RESULTS A total of 86 patients with L4–5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p < 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2 groups in clinical outcomes at each evaluation time point. Radiological evaluations were also similar and the complication rates were equally low in both groups. CONCLUSIONS At 32.7 months postoperation, the clinical and radiological outcomes of DDS were similar to those of MI-TLIF for Grade I degenerative spondylolisthesis at L4–5. DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term. Thus, the comparable results between the 2 groups in this study require longer follow-up to corroborate.

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“…There are a few such reports from studies by Indian authors. Jhala et al, [16] prospectively studied 23 patients with MIS TLIF for degenerative spine disorders and demonstrated a good clinicoradiological outcome. Kandwal et al, [17] analyzed the usefulness of MIS TLIF in 23 cases of tuberculous spondylitis and found a good fusion rate with the use of the procedure.…”

Section: Discussionmentioning

confidence: 99%