Open Transforaminal Lumbar Interbody Fusion Group Research Articles

Long-Term Incidence of Adjacent Segmental Pathology After Minimally Invasive vs. Open Transforaminal Lumbar Interbody Fusion.

Retrospective cohort study. To compare the incidence of adjacent segmental pathology (ASP) following minimally invasive (MI) vs open transforaminal lumbar interbody fusion (TLIF) and to identify factors linked to ASP requiring reoperation. This retrospective study reviewed the outcomes of patients who underwent MI-TLIF or open TLIF. Radiographic ASP (RASP) was evaluated using X-ray imaging to distinguish between degenerative changes, spondylolisthesis, and instability in the adjacent spinal segment. Clinical ASP (CASP) was assessed with the visual analog scale score for leg and back pain and the Oswestry disability index. Patient data were collected 1, 2, 5, and 10 years postoperatively. The timing and frequency of ASP reoperation were analyzed. Five years postoperatively, the RASP rate was 35.23% and 45.95% in the MI-TLIF and open TLIF groups. The frequency of CASP differed significantly between the MI-TLIF and open TLIF groups at 1 year postoperatively. The rates of RASP, CASP, and ASP necessitating reoperation were not significantly different 10years postoperatively. Cranial facet violation significantly affected ASP in both groups. In the open TLIF group, preoperative adjacent segment disc degeneration significantly influenced ASP. The RASP rate at 5years postoperatively and the CASP rate at 1year postoperatively differed significantly between groups. There was no difference in the rate of ASP requiring reoperation. Cranial facet violation is a crucial driving factor for ASP after both surgical procedures.

Early result of percutaneous full-endoscopic transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative diseases: a retrospective study.

The study aimed to evaluate the short-term clinical efficacy of percutaneous full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) for lumbar degenerative diseases (LDD). From July 2020 to July 2021, 93 patients who underwent single-level lumbar fusion procedure were retrospective analysis. The patients were divided into Endo-TLIF group and transforaminal lumbar interbody fusion (TLIF) group. General demographic and perioperative data were recorded, the clinical outcomes were evaluated using visual analogue scale (VAS) and oswestry disability index (ODI). The disk height (DH) was compared between the two groups. All of the surgical procedures were successfully completed, and the patients were followed for a minimum of 2 years. Intraoperative blood loss, drainage volume, time to independent ambulation and hospital length of stay in the Endo-TLIF group were significantly decreased in comparison with the open TLIF group (p < 0.05). The VAS for back pain on postoperative 7day and ODI on postoperative 1 month were lower in the Endo-TLIF group than in the open TLIF group (P < 0.05), but no significant difference at 1 year and 2 years postoperatively (P > 0.05). The VAS score of leg pain had no demographic statistically significant differences between the groups (P > 0.05). The DH were significantly heightened after surgery compared to the preoperative height (p < 0.05). Endo-TLIF is a minimally invasive, safety surgery which can achieve comparable short-term effects as open TLIF. It may be a promising option for the treatment of LDD.

Comparative Analysis of Open Transforaminal Lumbar Interbody Fusion and Wiltse Transforaminal Lumbar Interbody Fusion Approaches for Treating Single-Level Lumbar Spondylolisthesis: A Single-Center Retrospective Study

Background: The aim of this study is to compare the surgical outcomes of two different surgical approaches, open transforaminal lumbar interbody fusion (TLIF) and Wiltse TLIF, in the treatment of single-level lumbar spondylolisthesis and also to provide the advantages and disadvantages of each approach. Methods: This retrospective study included 600 patients with single-level lumbar spondylolisthesis who underwent fusion surgery at a single academic institution between January 2018 and December 2022. Patients were divided into two groups: traditional open TLIF (group A; 300 patients) and the Wiltse TLIF approach (group B; 300 patients). Preoperative diagnostic tests were performed on all patients. Results: The fluoroscopy time for the Wiltse TLIF group was longer, whereas the mean blood loss for the Wiltse TLIF approach was less. Both techniques resulted in significant improvements in pain relief and functional disability, with no significant difference between the two groups in terms of their pre- or post-operative (Oswestry Disability Index) ODI scores. The Wiltse TLIF technique resulted in significantly shorter hospital stays and had a lower rate of complications compared with the open TLIF technique. Conclusion: The Wiltse TLIF approach showed advantages in shorter surgical times, reduced blood loss, and shorter hospital stays, whereas the traditional open TLIF approach exhibited shorter fluoroscopy times.

Does indirect decompression by oblique lateral interbody fusion produce similar clinical and radiological outcomes to direct decompression by open transforaminal lumbar interbody fusion.

Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases. Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software. Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters post-surgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration. Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion.

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of II° lumbar isthmic spondylolisthesis: A retrospective cohort study.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is not suitable for high-grade isthmic spondylolisthesis, whether MIS-TLIF can treat II° lumbar isthmic spondylolisthesis (IS) is still controversial. This retrospective cohort study compared the clinical efficacy of MIS-TLIF and open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of II° lumbar IS. From January 2017 to January 2023, 101 patients with II° lumbar IS were diagnosed in our hospital and underwent surgical treatment, of which 53 received MIS-TLIF surgery and 48 received OPEN-TLIF surgery. The operation time, blood loss and surgical complications were compared between the 2 groups. The pain, function, reduction rate and fusion rate of the patients were evaluated during follow-up. The amount of intraoperative blood loss, postoperative drainage, and postoperative hospital stay in the MIS-TLIF group were significantly lower than those in the OPEN-TLIF group were (P < .01). In the MIS-TLIF group, there were 1 case of dural sac injury and 3 cases of lower limb paralysis. The complication rate of MIS-TLIF was lower than the OPEN-TLIF group (P = .032). In the visual analog scale score of low back pain, the MIS-TLIF group was lower than the OPEN-TLIF group after operation and at the last follow-up. There were no significant differences in postoperative leg pain score, slippage rate, and fusion rate between the 2 groups. Compared with OPEN-TLIF, MIS-TLIF has the advantages of better low back pain relief, less trauma, less bleeding and faster recovery, and is worthy of clinical promotion.

Which surgery is better for obese patients with lumbar degenerative diseases: open TLIF or Endo-LIF? A retrospective matched case–control study

ObjectiveThis study aimed to evaluate short-term clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (Endo-LIF) in the treatment of obese patients with lumbar degenerative diseases (LDD). MethodsPatients who underwent single-level lumbar fusion surgery from July 2020 to July 2022 were retrospectively analyzed in this study. The main inclusion criterion was a body mass index (BMI) ≥30kg/m2. A matched case-control design was conducted to compare the short-term outcomes between the Endo-LIF and transforaminal lumbar interbody fusion (TLIF) in obese patients. Cases were defined as those who underwent Endo-LIF, and controls were matched from those patients with open TLIF according to corresponding matched criteria. Surgeon satisfaction was evaluated by questionnaires at the end of each surgery, patient satisfaction and their willingness to undergo the same surgery again were collected. ResultsTwo groups of patients were successfully completed surgery. In comparison with the open TLIF group, the Endo-LIF group had significantly less blood loss, less time to postoperative ambulation, less postoperative complications and shorter hospitalization days, but longer operation time and x-ray exposure times. The satisfaction of surgeons and patients in Endo-LIF group significantly were superior to open TLIF group. ConclusionEndo-LIF is a safe and effective surgery in the treatment of obese patients. Although this procedure needs longer operation time and x-ray exposure times, it still maybe a promising option for obese patients with LDD.

Comparison of the total and hidden blood loss in patients undergoing single-level open and unilateral biportal endoscopic transforaminal lumbar interbody fusion: a retrospective case control study

PurposeThis study aimed to compare total blood loss (TBL) and hidden blood loss (HBL) in patients undergoing single-level open transforaminal lumbar interbody fusion (O-TLIF) and unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF).MethodsA total of 53 patients who underwent ULIF and 53 patients who underwent O-TLIF from March 2020 to July 2022 were retrospectively reviewed. The Nadler’s formula was employed to estimate the patient’s blood volume (PBV), Gross’s formula to estimate TBL, and Sehat’s formula to estimate HBL. The obtained data were then analyzed with independent t test, chi-squared test, and analysis of covariance.ResultsTBL and measured blood loss (MBL) in ULIF group (326.86 ± 223.45 ml, 99.00 ± 72.81 ml) was significantly lower than O-TLIF group (427.97 ± 280.52 ml, 270.66 ± 102.34 ml). Nevertheless, the HBL in ULIF group was higher than that in O-TLIF group (227.86 ± 221.75 ml vs 157.31 ± 268.08 ml), however this was not statistically significant (p = 0.143). The HBL was 69.71 ± 23.72% of TBL in ULIF group and 36.76 ± 18.79% of TBL in O-TLIF group. Patients in ULIF group had lower TBL and MBL, shorter duration of drainage, lower postoperative anemia, and shorter postoperative hospital stay compared to those in O-TLIF group.ConclusionsPerioperative HBL should not be neglected in patients undergoing ULIF or O-TILF, as it accounts for a large percentage of TBL in both groups. ULIF is associated with lower TBL and MBL, postoperative anemia, shorter postoperative hospital stays compared with O-TLIF.

Which Is Better in Clinical and Radiological Outcomes for Lumbar Degenerative Disease of Two Segments: MIS-TLIF or OPEN-TLIF?

To compare the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of two-level lumbar degenerative diseases. The clinical data of 112 patients were retrospectively analyzed, and were divided into an MIS-TLIF group and OPEN-TLIF group. The operative time, intraoperative fluoroscopy, blood loss, postoperative drainage volume, bed rest time, the content of creatine kinase(CK) and complications, were recorded. VAS score and ODI index were used to evaluate clinical efficacy. Bridwell grading was used to evaluate postoperative interbody fusion. Screw position was evaluated by Rao grading. Compared with the OPEN-TLIF group, the MIS-TLIF group had longer operation times, more intraoperative fluoroscopy times, but shorter postoperative bed times (p &lt; 0.05). There were no significant differences in blood loss, postoperative drainage and postoperative CK content between the two groups (p &gt; 0.05). There was no difference in VAS score and ODI index during the follow-up (p &gt; 0.05). There was no significant difference in the interbody fusion rate between the two groups (p &gt; 0.05). There was no significant difference in the distribution of type A screws, but the type B screw in the MIS-TLIF group was higher (p &lt; 0.05). There was no difference in the incidence of complications between the two groups (p &gt; 0.05). The postoperative quality of life score and radiological outcomes of the two types of surgery in two-level lumbar degenerative diseases was similar, and there was no significant difference in muscle injury and complications, but the operation time and intraoperative radiation exposurewere higher than in the OPEN-TLIF group, and the pedicle screws were more likely to deviate laterally out of the vertebral body. Therefore, OPEN-TLIF is recommended for patients with lumbar degenerative diseases of two segments.

224. Comparing 5-year outcomes between matched open and minimally invasive transforaminal lumbar interbody fusion in the treatment of single level lumbar degenerative disease

224. Comparing 5-year outcomes between matched open and minimally invasive transforaminal lumbar interbody fusion in the treatment of single level lumbar degenerative disease

Comparison of minimally invasive and open TLIF outcomes with more than seven years of follow-up

BackgroundFew studies directly comparing minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) and open TLIF offering long-term follow-up data have been performed to date. Therefore, we sought to compare mid- to long-term outcomes between these two surgical approaches. MethodsThis was a retrospective data analysis of two surgical groups. We analyzed the details of 97 patients with degenerative lumbar disease who were treated with MI TLIF (n = 55) or open TLIF (n = 42) between 2011–2014 and had at least seven years of follow-up data available. Peri- and postoperative outcomes were compared. To evaluate rates of adjacent segment disease (ASD) and revisions, frequencies of radiologic, symptomatic, and operative ASD were analyzed accordingly. ResultsIn terms of clinical outcome, the Oswestry Disability Index and visual analog scale scores were significantly reduced, with no difference between the groups. However, data for several peri- and postoperative outcomes, including perioperative blood loss, ambulation day, hospital stay, and operation time, varied in a manner favoring the MI TLIF group (P < 0.05). Rates of radiologic ASD and symptomatic ASD were significantly higher in the open TLIF group beginning at five years of follow-up (P < 0.05), while the rate of operative ASD and the revision rate were similar between the groups. Other long-term outcomes, including fusion rate and complications, remained similar between the two groups at 7 years. ConclusionPatients undergoing MI TLIF showed favorable immediate postoperative outcomes and less radiographic ASD. However, the rates of fusion and operative ASD remained similar between the two groups after 7 years of follow-up.

Ten-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Spondylolisthesis.

A retrospective observational study. This study investigated the clinical and radiological results of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (TLIF) in patients with single-level lumbar spondylolisthesis over a 10-year period. Few studies have compared 10-year follow-up outcomes between MI-TLIF and open TLIF. We retrospectively collected the outcome data of patients with single-level lumbar spondylolisthesis who underwent TLIF procedures using an MI (n = 108) or open (n = 53) approach. Fifty-two (48%) and 31 (58%) patients in the MI-TLIF and open TLIF groups, respectively, completed the 10-year follow-up. A primary clinical outcome included the Oswestry Disability Index (ODI) as well as visual analog scale (VAS) scores for back and leg pain at baseline and at 2, 5, and 10 years postoperatively. The radiographic fusion rate and incidence of secondary surgery due to adjacent segment disease were assessed at 2, 5, and 10 years postoperatively. Intraoperative blood loss and length of hospitalization were significantly lower in the MI-TLIF group than in the open TLIF group. At 2 years postoperatively, the ODI and VAS scores for back and leg pain were significantly lower in the MI-TLIF group than in the open TLIF group. No significant differences were found in VAS scores for back and leg pain or ODI scores between the two groups at 10 years postoperatively. Radiographic fusion rates and prevalence of secondary surgery for adjacent segment disease were not significantly different between the groups at 10 years postoperatively. Efficacy of MI-TLIF for patients with single-level lumbar spondylolisthesis is comparable to that of open TLIF over 10-years. However, MI-TLIF may have superior perioperative recovery and 2-year postoperative functional outcomes than open TLIF.Level of Evidence: 3.

117. Minimally invasive transforaminal lumbar interbody fusion increases late-term rates of pseudarthrosis versus open approach

<h3>BACKGROUND CONTEXT</h3> Lumbar fusion has developed into an effective surgical treatment option for patients with various lumbar pathologies including discogenic pain, stenosis and spinal instability. Popular minimally-invasive (MI) fusion techniques, such as transforaminal lumbar interbody fusion (TLIF) have been increasingly utilized by spinal surgeons, offering similar clinical outcomes to traditional open approaches and often reporting decreased blood loss and complications in the long term. Despite a number of reports comparing open versus MI-TLIF, literature stratifying return to OR (RTO) complications between the two approaches by time after surgery is limited. Therefore, the purpose of this study was to determine the differences in early, late and long-term revision rates between open and MI-TLIF. <h3>PURPOSE</h3> To determine differences in early, late and long-term revision rates between MI and open TLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 423 consecutive patients from 2012-2018 with a minimum follow-up of 2 years. Of the total, 127 underwent open TLIF and 296 underwent MI-TLIF. <h3>OUTCOME MEASURES</h3> (1) Return to OR revision rate, (2) pseudarthrosis proportion, (3) ASD proportion. <h3>Methods</h3> A retrospective review was performed to identify all patients between 2012-2018 who underwent 1- or 2-level open or MI-TLIF with a minimum follow-up of 2 years. Demographic data were compared between groups. RTO complications were noted and grouped according to categories related to infection, neurologic, fusion status, hardware and global alignment. These complications were then stratified by early (<6 months), late (6 months-2 years), and long-term (>2 years) time periods. Standard binominal and categorical comparative analyses were performed. <h3>Results</h3> A total of 423 consecutive patients were included; 127 in the open TLIF cohort and 296 in the MI-TLIF cohort. There were 67 males and 60 females in the open TLIF group compared to 177 males and 119 females in the MI-TLIF group (p= 0.180). Mean age was 54.1 years (21.9-79.2). Mean follow-up for the open TLIF and MI-TLIF groups were 67.9 and 69.6 months, respectively (p= 0.633). The overall RTO rate was 10.8% in the MI-TLIF cohort and 11.8% in the open TLIF cohort (p= 0.764). The open TLIF cohort had a significantly lower incidence of pseudarthrosis requiring RTO at the late-term time point (p= 0.042). There were no significant differences with respect to rates of adjacent segment disease (ASD) or any other particular complication requiring RTO. RTO rates at respective time points were 2.4%, 5.7%, and 2.7% for the MI-TLIF group and 5.5%, 0.8%, and 5.5% for the open TLIF group. Subgroup analysis of single-level operations only (75 open TLIF vs 255 MI-TLIF) demonstrated a significantly lower incidence of pseudarthrosis and ASD at both the late- and long-term time points (p= <0.001) in the open TLIF cohort, with no significant differences between overall RTO rates or any other complication (p= 0.333). <h3>Conclusions</h3> Open and MI-TLIF have both been shown to provide equivalent long-term clinical outcomes. In this study, patients undergoing open TLIF had significantly lower rates of pseudarthrosis compared to MI-TLIF. Open TLIF should be considered in patients with risk factors for nonunion; however, larger cohort studies are required to corroborate these findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion.

The midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF. From a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D. Of 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551). Compared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

Treatment of grade I and II degree degenerative lumbar spondylolisthesis with minimally invasive surgery-transforaminal lumbar interbody fusion under Quadrant channel

To investigate the advantages of minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant channel in the treatment of grade I and II degree degenerative lumbar spondylolisthesis. The clinical data of 100 patients with grade I and II degree degenerative lumbar spondylolisthesis treated from March 2014 to March 2017 were retrospectively analyzed. Among them, 50 patients were treated with MIS-TLIF, including 19 males and 31 females, aged from 44 to 73 years old with an average of (49.83±15.46) years old; course of disease from 6 months to 7 years with the mean of (22.18±4.74) months; L₄ slippage was in 30 cases and L₅ slippage was in 20 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 29 cases of I degree slip and 21 cases of II degree slip. Other 50 patients were treated with open-transforaminal lumbar interbody fusion(OPEN-TLIF), including 23 males and 27 females, aged from 40 to 77 years old with an average of(50.67±14.36) years old; course of disease from 6 months to 10 years with the mean of (20.56±5.37) months; L₄ slippage was in 33 cases and L₅ slippage was in 17 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 34 cases of I degree slip and 16 cases of II degree slip. The operation time, length of surgical incision, intraoperative blood loss, postoperative drainage, and serum creatine kinase(CK-MM) levels before surgery and 1 day after surgery were observed. Visual analogue scale(VAS), Japanese Orthopedic Association Score (JOA), and Oswestry dysfunction index (ODI) were compared between the two groups before and after surgery. According to the imaging data, the slip rate, intervertebral space height and slip angle of the two groups before and 12 months (last follow-up) were compared. Intervertebral fusion was evaluated according to lumbar X-ray and CT at 6 and 12 months postoperatively. The clinical effect was evaluated according to the MacNab criteria at 12 months after surgery. All the patients were followed up for 12 months. In MIS-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (118.48±21.97) min, (3.74±0.74) cm, (148.78±32.32) ml, (84.85±16.37) ml, respectively, CK-MM level was (72.31±9.79) μ/L before surgery and (415.12±25.89) μ/L at the first day after surgery. In OPEN-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (115.40±11.94) min, (8.46±0.69) cm, (219.27±48.33) ml, (157.69±31.61) ml, respectively, CK-MM level was (75.48±10.73) μ/L before surgery and (506.69±37.86) μ/L at the first day after surgery. The intraoperative blood loss, postoperative drainage volume, length of surgical incision, and CK-MM level on the first postoperative day were lower in MIS-TLIF group than in OPEN-TLIF group(P<0.05), but the operation time and preoperative CK-MM levels were compared between two groups, the difference was not statistically significant (P>0.05). There were no significant differences in ODI, VAS, and JOA scores before surgery(P>0.05). The ODI, VAS, and JOA scores were significantly improved after surgery(P<0.05), and the scores of MIS-TLIF group were better than those of OPEN-TLIF group(P<0.05). At the last follow-up, the slip rate, slip angle and intervertebral space height were significantly improved in the same group(P<0.05), but there was no significant difference between two groups(P>0.05). There was no significant difference in intervertebral fusion between groups at 6 and 12 months after operation(P>0.05). According to the MacNab standard, 40 cases got excellent results, 7 good, 3 fair in MIS-TLIF group, and 35 cases got excellent results, 10 good, 5 fair in OPEN-TLIF group. One patient had incision exudation and delayed healing in MIS-TLIF group. And in OPEN-TLIF group, 1 patient had local muscle necrosis on the right side of L₅ and the bacterial culture of the secretions was negative in the different three times and the right internal fixation device was taken out after the second operation completely debridement, and finally obtained delayed healing. The MIS-TLIF under Quadrant channel has advantage of minimally invasive trauma, less bleeding, faster function recovery and better effect in surgical treatment of grade I and II degree degenerative lumbar spondylolisthesis.

The efficacy and complications of minimally invasive vs. the traditional open transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis

Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbarinterbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolisthesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF (MIS-TLIF) group and 74 cases in traditional open TLIF group. The general information (age, gender, isthmic or degenerative type, percentage of slip degree, levels), operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale (VAS) of lowback pain and leg pain, and Oswestry Disability Index (ODI) were recorded and collected. The posterior height of the intervertebralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and surgicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml(P<0.001). The length of postoperative hospital stay was 5.9±1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3±3.1 days(P<0.001). The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant difference was found between them. The VAS ofback pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5±7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significantly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in MIS-TLIF group was 1.73±1.21, 1.93±1.48, and 25.4±6.8 at 5years follow up, and in Open TLIF was 1.85±1.02, 1.85±1.33 and 26.1±6.5, respectively, no significant difference between twogroups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.52±1.67 mm and 12.11°±3.44° at 2 years follow up, while the open TLIF was 9.88±1.54 mm and 12.98±3.83°, all of them were significantly different to pre-operation,however, no significant difference between two groups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.37±1.46 mm and 11.55°±2.77°, while the open TLIF was 9.66±1.68 mm and 12.59°±4.23°, no significant difference between two groups. The percentage of slip degree was reduced to 5.2%±4.6% in MIS-TLIF and 5.6%±4.3% in open TLIF, the cross-sectional area of spinal canal was enlarged to 139.7±19.5 mm2 and 141.7±20.7 mm2, no significant difference between two groups either. Conclusion MIS-TLIF has less blood loss, shorter postoperative hospital stay than open TLIF, and similar clinical pain and functional outcomes. MIS-TLIF is suggested to be a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis(Grade II or less). Key words: Lumbar vertebrae; Spondylolysis; Surgical procedures, minimally invasive; Spinal fusion

Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up

Compare the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) in the treatment of single segmental lumbar spondylolisthesis. From 2010-01 to 2015-10, in total, 167 patients with single segmental spondylolisthesis treated by TLIF were included, 79 cases in minimally invasive TLIF (MI-TLIF) group and 88 cases in open TLIF group. The peri-operative parameters of operative time, estimated blood loss and length of postoperative hospital stay was recorded, as well as complications. Visual Analogue Scale (VAS) of low back pain and leg pain, and Oswestry Disability Index (ODI) were used to assess the pain and functional outcomes at pre-operatively, 3 months/1 year/2 years/5 years after operation. The radiographic parameters of posterior height of the intervertebral space and segmental lordosis were measured too. No significantly difference was found at baseline characteristic data of age, gender ratio, the percentage of degenerative and isthmic spondylolisthesis, the percentage of slip, and segmental distribution between MI-TLIF and open TLIF groups. MI-TLIF group had less estimated intra-operative blood loss (163.7±49.6 mL) than open TLIF group (243.3±70.2 mL, P<0.001) and had shorter post-operative hospital stay (5.8±1.4 days) than open TLIF group (7.3±2.9 days, P<0.001). Both MI-TLIF and open TLIF can significantly reduce the VAS of low back pain, VAS of leg pain, ODI, and improve the posterior height of the intervertebral space and segmental lordosis, but no significantly difference was found of them between two groups. Our study suggests that MI-TLIF is a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (grade II or less), and it has advantages of less blood loss, postoperative hospital stay when compared to open TLIF.

Effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion and traditional open surgery in the treatment of lumbar spondylolisthesis

Objective: To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis. Methods: A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ(2) were used to analyze data. Results: There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P>0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs. (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs. (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs. (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs. (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs. (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs. 4.2±2.4) (t=2.762-16.738, all P<0.05), but need more operation time ((151.3±12.3) minutes vs. (102.2±7.1) minutes) and more X-ray radiation exposure ((26.1±3.3) seconds vs. (5.5±2.1) seconds) (t=6.125, 15.168, both P<0.01). In both groups ODI was significantly lower in final follow-up than that of the pre-operation (t=12.215, 14.036, P<0.01). Intervertebral disc height of the final follow-up in both groups were significantly larger than that of the preoperation (robot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs. (7.5 ± 1.9) mm, traditional open TLIF group: (12.7 ± 2.5) mm vs. (7.9±2.0) mm), and so was the lumbar lordosis angle (robot-assisted minimally invasive TLIF group: (48.7±9.2)°vs. (39.6±7.9)°, traditional open TLIF group: (50.1±10.8)°vs. (41.4±8.8)°), the lordosis angle of the slippage segment (robot-assisted minimally invasive TLIF group: (18.7±5.6)°vs. (10.9±3.8)°, traditional open TLIF group: (17.6±6.1)°vs.(8.7±3.2)°) (t=4.128-16.738, all P<0.01). Slippage rate of the final follow-up in both groups were significantly smaller than those of the pre-operation (robot-assisted minimally invasive TLIF group: (5.3±2.3) % vs. (27.8±7.2) %, traditional open TLIF group: (6.6±2.8) % vs. (29.1±9.5) %) (t=11.410, 18.504, both P<0.01). There was no difference of the upper data between two groups (t=0.106-1.227, P>0.05). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ(2)=4.247, P=0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ(2)=0.366, P=0.545). Conclusions: In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less perioperative bleeding, less post-operative pain, and quicker recovery than traditional open TLIF surgery, but it needs more operation time and radiation exposure.

Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion.

Background:The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF.Materials and Methods:All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17).Results:129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma.Conclusion:The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

Modified transforaminal lumbar interbody fusion for acute and chronic lumbar intervertebral disc injury via minimally invasive expandable access system

Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion (TLIF) assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury. Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive (Group A) or open TLIF (Group B). Location for disc injury was at L3/4 in 5 patients, L4/5 in 28 patients and L5-S1 in 12 patients. Group A composing 12 males and 10 females showed age of (53.70±3.59) years (range, 43 to 67 years). Group B composing 14 males and 9 females showed age of (54.80±4.37)years (range, 42 to 68 years). Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications. Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and bone fusion rate. Results Except for the comparable operation time, group A was associated with better results in the blood loss [(152.1±15.5)ml vs (409.9±28.3)ml], drainage volume[(106.1±14.3)ml vs (223.0±19.4)ml], ambulation time[(4.5±1.1)d vs (8.9±1.4)d] and 1-week postoperative VAS [(3.0±0.7) points vs (4.7±0.4) points](P 0.05). Bone fusion rate in Group A was 95% (21/22) versus 96% (22/23) in Group B 6-month postoperatively (P>0.05). No nerve root injury, intervertebral space infection or other complications occurred. Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral disc injury and has similar long-term clinical outcomes with open TLIF. Key words: Intervertebral disc; Lumbar vertebrae; Endoscopes; Transforaminal lumbar interbody fusion

Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion: Early Outcome Observations

Aim: To compare early clinical and surgical outcome of patients treated with open transforaminal lumbar interbody fusion (O-TLIF) vs minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Materials and methods: Sixty-two consecutive patients from 2011 to 2013 undergoing transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis and lumbar spinal stenosis were included in the study. For analysis, they were divided into two groups based on whether TLIF was done by a conventional open technique (O-TLIF, 31 cases) or minimally invasive tubular retractor-assisted technique (MIS-TLIF, 31 cases). The demographic profile, clinical and surgical outcome variables, including pre- and postoperative visual analog scale (VAS), Japanese orthopedic association (JOA) scores and JOA recovery rates were noted in both the groups. Results: The median duration of follow-up was 9 months in MIS-TLIF group and 14 months in O-TLIF group. Preoperative clinical variables were comparable in both the groups. MIS-TLIF group had lesser mean intraoperative blood loss, lesser analgesic requirement, shorter hospital stay and earlier return to work as compared to O-TLIF group. Improvements in postoperative VAS for leg pain were similar in both the groups. Immediate postoperative and follow-up VAS for back pain were lower while mean JOA score and mean JOA recovery rate were significantly higher in MIS-TLIF group as compared to O-TLIF group. Conclusion: Minimally invasive transforaminal lumbar interbody fusion resulted in lesser blood loss, lesser analgesic requirement, shorter hospital stay, earlier return to work and improved functional outcome in terms of higher JOA recovery rates as compared to O-TLIF.