The unfeasible made feasible: lumbar minimally invasive hybrid stabilization with dynamic rod and mini-open transforaminal lumbar interbody fusion.

Abstract

Posterior dynamic stabilization of the lumbar spine is spreading as a viable alternative to spinal fusion, aiming to achieve an equally satisfactory clinical outcome without making the spine completely rigid. We describe the feasibility of a minimally invasive surgical technique used to implant a hybrid system and perform a mini-open (m-open) transforaminal lumbar interbody fusion (TLIF) in patients suffering from degenerative spondylolistesis and adjacent level's degenerative disc disease (DDD). Three patients (2 females), suffering from degenerative spondylolistesis and adjacent level's DDD, underwent two-level hybrid stabilization combining a rigid, circumferential fusion (with m-open TLIF) at the level involved by spondylolistesis and a dynamic stabilization at the adjacent one. Screws, hybrid rods as well as interbody cages were introduced using a simple minimally invasive technique. Clinical and radiological evaluation was performed pre- and postoperatively, and at 3, 6 and 12 months, respectively, using the Visual Analogue Scale and the Oswestry Disability Index questionnaire. Mean VAS and ODI score reduced from 8.3, preoperatively, to 5 and from 72.66 to 43.98, respectively. No surgery-related complications were observed and the mean postoperative hospitalization was 2.5 days. Postoperative and follow-up flexion-extension X-rays showed persisting motion at dynamically stabilized levels. Follow-up CT imaging confirmed interbody fusion at TLIF levels in all patients. Dynamic and hybrid stabilizations of the lumbar spine are typically performed using open surgery. This study reports the feasibility of a hybrid stabilization with m-open TLIF performed using a minimally invasive technique.