Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis

Eleftherios Archavlis

doi:10.4172/2165-7939.s5-004

Abstract

Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (MI-TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis with severe facet joint osteoarthritis (FJO). Methods: This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO) between June 2010 and June 2011. Blood loss, operative time and intraoperative complications were assessed in all surgically treated patients who were treated with MIS decompression, MI-TLIF and percutaneous transpedicular instrumentation. Clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back pain, leg pain, and activity level. Satisfaction was assessed with VAS for satisfaction. Radiological follow-up includes x-ray films, computed tomography and in some cases magnetic tomography scan. Results: Twenty four cases with severe stenotic changes accompanied by severe FJO were treated with minimally invasive procedure. The minimum follow-up was 6 months with a mean of 8 months. The mean preoperative ODI score was 46.8, decreasing to a mean of 23 postoperatively. The mean VAS leg and back pain scores were 67.5 improving to means of 25.8. Twenty one out of 24 cases experienced a clinical benefit according to VAS for satisfaction and ODI. Complications included wound healing disturbance (4%), CSF fistula (4%) and contralateral radiculopathy due to articular bone spurs (8%). The accuracy of pedicle screws was high and only one revision surgery was performed. Conclusion: MIS for severe stenotic spondylolisthesis leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. MIS-TLIF and percutaneous pedicle screw insertion constitute a promising treatment alternative for patients with severe stenosis and facet joint osteoarthritis.

Highlights

A basic principle of minimally invasive spine surgery (MIS) is to effectively treat pathology with minimal disturbance of normal anatomy, some reports suggest that the limited exposure that results from these techniques can result in incomplete treatment of pathology with no clear-cut advantage over traditional techniques [1,2]
The severity of lumbar spinal stenosis at the affected level was based on the morphology of the dural sac on magnetic resonance images according to Schizas et al, who described a 7-grade classification based on the morphology of the dural sac as observed on T2 axial magnetic resonance images based on the rootlet/cerebrospinal fluid ratio
The minimal invasive procedure was performed in 24 patients

Summary

Introduction

A basic principle of minimally invasive spine surgery (MIS) is to effectively treat pathology with minimal disturbance of normal anatomy, some reports suggest that the limited exposure that results from these techniques can result in incomplete treatment of pathology with no clear-cut advantage over traditional techniques [1,2].The avoidance of complications is more challenging through limited surgical portals [1]. Failure surgery and reoperation rates can increase, especially in the field of lumbar instrumentation [3,4]. In spite of these challenges, the evolution of MIS has exceeded that of traditional spine procedures over the past 2 decades [5,6,7,8,9,10]. The area of greatest controversy, is the handling of cases with degenerative spondylolisthesis with severe stenosis of the spinal canal [11]. The presence of severe arthritic changes of the facets is characteristic in many of these patients [12]. Some authors prefer to perform a laminectomy without fusion.

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