Paraspinal Muscle Sparing versus Percutaneous Screw Fixation : A Prospective and Comparative Study for the Treatment of L5-S1 Spondylolisthesis

Abstract

. Posterior instrumentation is frequently used to augment interbody fusion, and pedicle screws with rods are commonly employed for this purpose. However, traditional open PLIF for instrument implantation requires a large midline skin incision and extensive J Korean Neurosurg Soc 49 : 163-166, 2011 10.3340/jkns.2011 Copyright © 2011 The Korean Neurosurgical Society Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis.Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

“…Two studies in our systematic review did demonstrate improved early outcome scores in MIS PLIF over open PLIF; however, this effect was noticed during the early timeframe postoperatively and became negligible at [ 1-year followup. However, five studies did not find a benefit to MIS PLIF over open PLIF in terms of validated outcomes scores [4,11,20,26,28]. This suggests MIS may result in a quicker decrease in postoperative pain and functional recovery, but no studies in our review evaluated return to work status for patients.…”

“…Most studies had methodological defects, including but not limited to nonconsecutive enrollment of patients, inadequate baseline comparisons, inadequate measurement of clinical outcomes, and reported complications. Some studies did not use contemporary validated outcome measures [7,11]. Considerable heterogeneity was present in the data.…”

“…Compared with posterolateral and lateral approaches, PLIF may be advantageous, providing a wider area of intervertebral interbody graft bone contact surface, improved load-sharing, adequate access for complete decompression of the neural elements, restoration of neural foraminal height, and the ability to restore segmental lordosis at the involved level [1-3, 5, 10]. Multiple studies report a high fusion rate ranging between 89% and 97% with this technique [4,7,11,18,26,30,32].…”

“…Multiple studies report a high complication rate during the learning stage [6,16,23]. Recently, a number of comparative studies have compared the effectiveness of open PLIF and MIS PLIF for degenerative spinal conditions [4,7,11,18,20,26,28]. However, consensus regarding superiority of either approach is lacking as a result of inconsistent conclusions in the various studies.…”

Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis

“…Traditional procedures for symptomatic spondylolisthesis involve spinal decompression and fusion with supplemental instrumentation 6) . However, the traditional implantation of spinal instrumentation by midline approach requires extensive tissue dissection to expose entry points and provide the required lateral-to-medial orientation for optimal screw trajectory 8) . As a result, excessive dissection may result in the denervation of muscles and facet capsules, proximal facet joint damage, and the weakening of other supportive structures, and cause prolonged postoperative pain and functional disability 1 , 11) .…”