Outcomes of Transforaminal Lumbar Interbody Fusion Using Unilateral Versus Bilateral Interbody Cages

Abstract

Objective: To assess the impact of bilateral versus unilateral interbody cages on outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures.Methods: A retrospective review for primary, elective, single-level MIS TLIF procedures with bilateral posterior instrumentation from 2008–2020 was performed. Patients were grouped according to unilateral or bilateral interbody cage use. Procedures performed without static interbody cages or indicated for trauma, infection, malignancy were excluded. Patient-reported outcomes (PROs) included visual analogue scale (VAS), Oswestry Disability Index, 12-item Short Form health survey physical composite score (SF-12 PCS), PatientReported Outcome Measurement Information System physical function (PROMIS-PF). PROs were collected preoperatively and postoperatively. Change in PROs (Δ) was calculated and compared between groups. Achievement of minimum clinically important difference (MCID) was calculated using established values from the literature. Achievement rates were compared between groups using logistic regression.Results: The study included 151 patients, with 111 unilateral and 40 bilateral cage placements. Charlson Comorbidity Index, diabetes, and insurance status differed between groups (p < 0.050). Prevalence of degenerative and isthmic spondylolisthesis (both p ≤ 0.002), operative level (p = 0.003), and postoperative length of stay (p = 0.022) significantly differed between groups. The unilateral group had lower 1-year arthrodesis rates (p = 0.035). Preoperative VAS leg (p = 0.017) and SF-12 PCS (p = 0.045) were worse for the unilateral group. ΔPROMIS-PF was greater for the bilateral group at 2 years (p = 0.001). Majority of patients achieved an overall MCID for all PROs, except VAS leg (bilateral group).Conclusion: While preoperative status and postoperative arthrodesis rates differed, patients achieved an MCID at similar rates regardless of use of unilateral or bilateral cages.

Safety and efficacy of unilateral and bilateral pedicle screw fixation for lumbar degenerative diseases by transforaminal lumbar interbody fusion: An updated systematic review and meta-analysis

“…VAS-Leg pain score was evaluated in 8 studies including 518 patients ( 20 , 21 , 23 , 25 , 27 , 29 , 31 , 32 ). The results of the fixed-effect model meta-analysis showed that: the overall difference between UPSF and BPSF was not statistically significant [SMD = 0.18, 95% CI (−0.00–0.36), P = 0.05; Figure 3 ].…”

Augmented Reality to Improve Surgical Workflow in Minimally Invasive Transforaminal Lumbar Interbody Fusion – A Feasibility Study With Case Series

“…Our case series demonstrated an average procedure time of 160.6 ± 31.9 minutes, suggesting that our AR-integrated workflow does not cause a relevant delay of the procedure. 4,25 However, our current study model does not allow us to determine the impact the use of AR has on duration of MIS-TLIF. The purpose of the current study was to develop an effective protocol for the reproducible application of AR for the MIS-TLIF.…”

“…The overall procedure time of a tubular MIS-TLIF in the literature is reported between 138.3±33.3 and 210.6±11.93 minutes. Our case series demonstrated an average procedure time of 160.6±31.9 minutes, suggesting that our AR-integrated workflow does not cause a relevant delay of the procedure [ 4 , 25 ]. However, our current study model does not allow us to determine the impact the use of AR has on duration of MIS-TLIF.…”

“…1,2 It has become a routine operation performed through traditional open or minimally-invasive techniques and is associated with excellent outcomes in appropriately selected patients. 3,4 By now it is defined by many predetermined land-This technology may be helpful for experienced surgeons when operating cases with challenging anatomical conditions like severe degenerative changes. Additionally, this technique offers enormous educational potential for novice surgeons and trainees.…”

“…Transforaminal lumbar interbody fusion (TLIF) is a well-established surgical technique for stabilizing and decompressing a spinal motion segment utilizing a unilateral facetectomy to access the disc space for implantation of a cage and/or bone graft [ 1 , 2 ]. It has become a routine operation performed through traditional open or minimally-invasive techniques and is associated with excellent outcomes in appropriately selected patients [ 3 , 4 ]. By now it is defined by many predetermined landmarks that help surgeons through the procedure [ 5 ].…”