Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to analyze the surgical outcomes in cases involving elderly patients who underwent single-level instrumented mini-open transforaminal lumbar interbody fusion (TLIF).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective review of 27 consecutive cases involving elderly patients (≥ 65 years of age) who underwent single-level instrumented mini-open TLIF and were followed up for at least 3 years. Degenerative spondylolisthesis was diagnosed in 16 patients, stenosis with instability in 8, and lytic spondylolisthesis in 3. All cases were Grade I or II based on the American Society of Anesthesiologists' classification system. Clinical outcomes were assessed using a visual analog scale, the Oswestry Disability Index, and patients' subjective satisfaction. Sagittal balance, bone union, and adjacent segment degeneration (ASD) were assessed using plain radiography and 3D CT.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean age of patients at the time of surgery was 69.3 years (range 65–80 years). Minor complications occurred in 2 patients (7.4%) in the perioperative period. At a mean follow-up duration of 38.6 months (range 36–42 months), clinical success was achieved in 88.9% of cases. The mean segmental lordosis and sacral tilt significantly increased after surgery (from 11.9 and 33.5° to 13.9 and 37.2°, p = 0.024 and p = 0.001, respectively). Solid fusion was achieved in 77.8% of the patients. Adjacent segment deterioration was found in 44.4% of the patients. No patients underwent revision surgery due to nonunion or ASD. The development of ASD was significantly related to postoperative sacral tilt (p = 0.006).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Single-level instrumented mini-open TLIF yielded good clinical and radiological outcomes with a low complication rate in elderly patients.</jats:p></jats:sec>

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

“…By way of historical comparison with traditional MIS TLIF, other studies have demonstrated 2°-3° of segmental correction in the sagittal plane. 15,21,23,48 In comparison with other forms of sagittal correction, historically MIS TLIF has shown only modest improvements in segmental lordotic angle. Additionally, the increase in segmental lordotic restoration in this study compares favorably to a weighted average increase of 3.9° published in a review by Uribe et al 43 Despite these positive findings, it is important to note that the question whether improvement in LL translates into actual improved clinical outcomes for treatment of spondylolisthesis has not been reliably answered in the literature.…”

Minimally Invasive Spine Surgery in the Nuevo Hospital Civil De Guadalajara "Dr. Juan I. Menchaca"

“…[1][2][3][4][5][6][7][8][9][10][11][16][17][18] These objectives are achieved through conventional spinal approaches that involve the detachment of the paraspinal musculature, its denervation and devascularization, in addition to injury to the ligamentary structures, in contrast to minimally invasive techniques, which try to minimize the damage to these structures. Minimally invasive techniques are able to limit exposure as much as possible and to reduce the retraction of the structures, resulting in the less collateral damage to the tissues, a measurable reduction in morbidity, and above all, a more rapid functional recovery without departing from the primary objective established for spine surgery.…”

“…Several prior studies established a valid justification for this type of procedure in terms of their similar results in neurological outcomes and the preservation of structures that are essential to the biomechanics of the spine. [1][2][3][4][5][6][7][8][9][10][11][16][17][18] Minimally invasive approaches have been developed for degenerative, traumatic, and neoplastic pathologies, among others.…”

“…[1][2][3][4][5][6][7][8][9][10][11] The particular characteristics of spine surgery require advances to be made prudently and more safely than in surgeries in other regions of the human body. In spite of the existing difficulties, the possibility of using techniques labeled "minimally invasive" in the spine is perhaps more important and sustainable than in other parts of the organism.…”

“…2 Approaches from the posterior part of the spine severely injure the posterior musculature with irrecoverable denervation and are a significant cause of surgical failure. 1,[3][4][5][6][7][8][9][10][11] Anterior spinal approaches require thoracotomies, laparotomies, lumbotomies, etc., all of which offer broad exposure but also severe injury to the adjacent tissues with undesirable, and sometimes definitive, secondary effects. [12][13][14][15] It is important to achieve outcomes similar to those of conventional surgery without most of its inconveniences of unnecessary damage to adjacent tissues.…”