Is Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion Sufficient in Patients with Claudication? A Comparative Matched Cohort Study

Abstract

To evaluate clinical and radiologic outcomes between bilateral decompression using the over-the-top technique (group 1) and unilateral decompression (group 2) in patients with claudication who underwent minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF). We enrolled patients with claudication who underwent MIS-TLIF from January 2017 to June 2019. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI), walking distance, and perioperative outcomes were compared between groups. Preoperative and 3-month postoperative magnetic resonance imaging assessed changes in canal cross-sectional area, foraminal height, and lateral recess area. Sixty-five consecutive patients with ≥1 year of follow-up were enrolled. VAS scores and ODI were not significantly different between groups (VAS and ODI, respectively, at 1 month follow-up, P= 0.62 and 0.88; 3 months follow-up, P= 0.96 and 0.53; 6 months follow-up, P= 0.10 and 0.85; and 12 months follow-up, P= 0.10 and 0.66). Operative time and blood loss between groups was not statistically significant (P= 0.43 and P= 0.55). There was also no difference in the length of hospital stay (P= 0.24). Canal dimensions increased in each group without significant differences between groups (cross-sectional area, P= 0.92; foraminal height [approach and contralateral side, respectively], P= 0.62 and 0.66; and lateral recess area [approach and contralateral side, respectively], P= 0.68 and 0.50). A unilateral approach with ipsilateral side direct decompression and contralateral indirect decompression in MIS-TLIF is sufficient for early clinical improvement in patients with claudication.