Abstract
This was a retrospective study. We aimed to compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of low-grade lumbar degenerative spondylolisthesis (LDS). 81 patients with LDS grades 1 and 2 treated in our spinal department from January 2014 to July 2016 were retrospectively analyzed. The MIS-TLIF group included 23 males and 11 females, while the TO-TLIF group included 29 males and 18 females. Follow-up points were set at 7 days, 3 months, 6 months, 12 months postoperatively and the last follow-up. Various clinical and radiological indicators were used to evaluate and compare the efficacy and safety between the two procedures. 8 cases (3 in the MIS-TLIF group and 5 in the TO-TLIF group) were loss of follow-up after discharge. And the remaining 73 patients were followed up for at least 2 years. No statistically significant difference was observed in the terms of age, sex, BMI, slippage grade, and surgical segments. The MIS-TLIF group had a longer operation and fluoroscopy time compared with the TO-TLIF group. But the MIS-TLIF group was associated with less blood loss, ambulation time, hospital stay, and time of return to work. In each group, significant improvement were observed in BP-VAS, ODI and vertebral slip ratio at any time-point of follow-up when compared with the preoperative condition. When the time-point of follow-up was less than 1 year, the MIS-TLIF group had significant advantages in the BP-VAS and ODI compared with TO-TLIF group. But no significant difference was observed in the BP-VAS and ODI at either 12 month follow-up or the last follow-up. Besides, no statistical difference was detected in vertebral slip ratio at any time-point of follow-up between the two groups. Successful intervertebral bone fusion was found in all patients and no significant difference was found in the incidence of total complications. Thus, we considered that MIS-TLIF and TO-TLIF both achieve satisfactory clinical efficacy in the treatment of low-grade single-segment LDS. But MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue damage, less blood loss and quicker recovery.
Highlights
We made the surgical decision for MIS versus TO-transforaminal lumbar interbody fusion (TLIF) under the precondition of patients’ general condition and preference. 34 patients who experienced MIS-TLIF and pereutaneous pediele screw fixation were set as the MIS-TLIF group, while 47 cases with traditional open TLIF and pedicle screw fixation were set as the TO-TLIF group
Inclusive criteria: 1) The age of patients was ranged from 50 to 80 years old; 2) Single-segment degenerative spondylolisthesis grade 1 or 2, which confirmed by imaging examination; 3) Persistent mechanical lower back pain with or without lower limb radiation pain; 4) Imaging characteristics were in accordance with clinical symptoms; 5) Regular conservative treatment had no obvious efficacy over 3 months, or recurrent attacks of the symptom; 6) The duration of follow-up was at least 2 years
No significant difference was observed in terms of age, gender, body mass index (BMI), slippage grade, surgical segments and pre-admission disease course between the two groups (P > 0.05, Table 1). 8 patients (3 cases in MIS-TLIF group and 5 cases in TO-TLIF group) were lost to follow-up after discharge
Summary
We aimed to compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of low-grade lumbar degenerative spondylolisthesis (LDS). Significant improvement were observed in BP-VAS, ODI and vertebral slip ratio at any time-point of follow-up when compared with the preoperative condition. When the time-point of follow-up was less than 1 year, the MISTLIF group had significant advantages in the BP-VAS and ODI compared with TO-TLIF group. We considered that MIS-TLIF and TO-TLIF both achieve satisfactory clinical efficacy in the treatment of low-grade singlesegment LDS. MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue damage, less blood loss and quicker recovery. This study was performed with the purpose of estimating and comparing the clinical efficacy and safety between MIS-TLIF and TO-TLIF
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