Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation

Deutsch, Harel; Musacchio, Michael J.

doi:10.3171/foc.2006.20.3.11

Cited by 125 publications

(119 citation statements)

References 13 publications

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“…Symptomatic misplaced pedicle screws (2%) and cage migration (2%) were also reported. Our complication and reoperation rates appear comparable to other results of minimally invasive transforaminal lumbar interbody fusion [3,4,6,8,14,16,19,[22][23][24][25]. In the series of Rouben et al [22], the overall rate for repeat surgery (14.2%) was higher than ours.…”

Section: Discussionsupporting

confidence: 86%

“…Our study demonstrated that minimally invasive transforaminal lumbar interbody fusion improved clinical scores in patients with spondylolisthesis and other lumbar degenerative diseases; that the improvements observed were greater than the minimal clinically important difference threshold [2,10], consistent with the standards of arthrodesis outcomes described in the literature [3,4,6,16,17,[19][20][21][22][23][24][25]; and that these improvements were maintained up to 5 years after surgery. Our study also illustrated a challenging learning curve for this procedure.…”

Section: Discussionsupporting

confidence: 83%

“…Multiple studies have reported favorable results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion [3,4,6,8,16,17,[20][21][22][23][24][25]. These studies described results from 6 to 49 months after surgery; however, to our knowledge, data at minimum 5-year followup have never been reported.…”

Section: Introductionmentioning

confidence: 91%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. Questions/purposes We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. Methods We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003)(2004)(2005)(2006)(2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. Results At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. Conclusions Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 91%

See 1 more Smart Citation

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…In recent years, there have been several case series and comparative studies on minimally invasive lumbar spine fusions [1,[6][7][8][9][10][11][12][13][14]. In the present study, percutaneous pedicle screw-rod instrumentation was used for MIS-PLF.…”

Section: Discussionmentioning

confidence: 95%

“…Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been reported by several authors [1,[7][8][9]14]. Subsequently, Foley et al [4] introduced a percutaneous pedicle screw insertion and rod assembly system (CD Horizon Sextant, Medtronic, Memphis, TN, USA) for MIS-TLIF.…”

Section: Introductionmentioning

confidence: 99%

Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis

et al. 2011

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Introduction In order to minimize perioperative invasiveness and improve the patients' functional capacity of daily living, we have performed minimally invasive lumbar decompression and posterolateral fusion (MIS-PLF) with percutaneous pedicle screw fixation for degenerative spondylolisthesis with spinal stenosis. Although several minimally invasive fusion procedures have been reported, no study has yet demonstrated the efficacy of MIS-PLF in degenerative spondylolisthesis of the lumbar spine. This study prospectively compared the mid-term clinical outcome of MIS-PLF with those of conventional PLF (open-PLF) focusing on perioperative invasiveness and patients' functional capacity of daily living. Materials and methods A total of 80 patients received single-level PLF for lumbar degenerative spondylolisthesis with spinal stenosis. There were 43 cases of MIS-PLF and 37 cases of open-PLF. The surgical technique of MIS-PLF included making a main incision (4 cm), and neural decompression followed by percutaneous pedicle screwing and rod insertion. The posterolateral gutter including the medial transverse process was decorticated and iliac bone graft was performed. The parameters analyzed up to a 2-year period included the operation time, intra and postoperative blood loss, Oswestry-Disability Index (ODI), Roland-Morris Questionnaire (RMQ), the Japanese Orthopaedic Association score, and the visual analogue scale of low back pain. The fusion rate and complications were also reviewed. Results The average operation time was statistically equivalent between the two groups. The intraoperative blood loss was significantly less in the MIS-PLF group (181 ml) when compared to the open-PLF group (453 ml). The postoperative bleeding on day 1 was also less in the MIS-PLF group (210 ml) when compared to the open-PLF group (406 ml). The ODI and RMQ scores rapidly decreased during the initial postoperative 2 weeks in the MIS-PLF group, and consistently maintained lower values than those in the open-PLF group at 3, 6, 12, and 24 months postoperatively. The fusion rate was statistically equivalent between the two groups (98 vs. 100%), and no major complications occurred. Conclusion The MIS-PLF utilizing a percutaneous pedicle screw system is less invasive compared to conventional open-PLF. The reduction in postoperative pain led to an increase in activity of daily living (ADL), demonstrating rapid improvement of several functional parameters. This superiority in the MIS-PLF group was maintained until 2 years postoperatively, suggesting that less invasive PLF offers better mid-term results in terms of reducing low back pain and improving patients' functional capacity of daily living. The MIS-PLF utilizing percutaneous pedicle screw fixation serves as an alternative technique, eliminating the need for conventional open approach.

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