Transforaminal Lumbar Interbody Fusion: Comparison between Open and Mini-Open Approaches with Two Years Follow-Up
Department of Neurosurgery, Lille University Hospital, Lille, France.Journal of Neurological Surgery. Part A: Central European Neurosurgery (Impact Factor: 0.61). 01/2013; 74(3). DOI: 10.1055/s-0032-1330956
Background Transforaminal lumbar interbody fusion (TLIF) is an efficient technique which can achieve a fusion rate of up to 90%. Minimally invasive approaches have become increasingly popular because they appear to minimize iatrogenic soft tissue and muscle injury. As minimally invasive TLIF gains popularity, its effectiveness compared with open TLIF has yet to be established. Objective A retrospective study was performed with the aim to compare long-term outcomes of patients who underwent mini-open TLIF with those who underwent open TLIF. Methods This is a retrospective review of prospectively collected data. Between 2005 and 2008, 100 patients underwent TLIF for low-grade spondylolisthesis or degenerative disc disease; 60 underwent open TLIF and 40 underwent mini-open TLIF. The mean age in each group was 48 years, and there were no statistically significant differences between the groups. Data were collected perioperatively. Pain and functional disability were measured using visual analogue scale (VAS) and Oswestry disability index (ODI) at 3 months, 6 months, 1 year, and 2 years. In addition, the fusion was evaluated at 1 year on a computerized tomography (CT) scan. Results The mean VAS improved from 7.3 to 3.8 for back pain and from 7 to 2.7 for leg pain and the ODI decreased from 60 to 30% at 2 years postoperatively. The fusion rate at 1 year was 98%. There were no statistical differences for the clinical and radiological outcomes between the groups. The mean operative time was 186 minutes in the open group and 170 minutes in the mini-open group (p < 0.05) and the mean blood loss was 486 mL in the open group and 148 mL in the mini-open group (p < 0.01). Conclusion The mini-open TLIF for symptomatic low-grade spondylolisthesis and degenerative disc disease is an effective option that achieves the same clinical and radiological outcomes at a minimum 2-year follow-up and reduces perioperative morbidity.
- World Neurosurgery 01/2013; 82(1-2). DOI:10.1016/j.wneu.2013.01.117 · 2.88 Impact Factor
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ABSTRACT: Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated discs, adjacent disc disease, disc degeneration, failed back surgery syndrome or pseudoartrosis all have symptoms of LBP in different ways. Chronic low back pain patients are advised to stay active, however, there is no strong evidence that exercise therapy is significantly different than other nonsurgical therapies. Not every patient with symptoms of LBP is an appropriate candidate for surgery. Even with thorough systematic reviews, no proof can be found for the benefit of surgery in patients with low back pain, without serious neurologic deficit. And subjects like psychologic and socio-demographic factors also seem to be influencing a patients perception of back pain, expectations of treatment, and outcomes of treatment. Open lumbar fusion procedures are typically lengthy procedures and require a long exposure, which may result in ischemic necrosis of the paraspinal musculature, atrophy, and prolonged back pain. Minimally invasive spine surgery needed to take care of a decrease in muscle injuries due to retraction and avoidance of disruption of the osseotendineous complex of the paraspinal muscles, especially the multifidus attachment to the spinous process and superior articular process. Therefore, effort has been made to develop percutaneous fusion, as well as fixation methods, which avoid the negative effects of open surgery. Several minimally invasive fusion strategies have been described, like anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and two lateral approaches (XLIF and DLIF), all with pro's and con's compared to open surgery and each other. The effect of MIS of all type is that patients have less blood loss, faster postoperative ambulation, lower use of opioids, and shorter in hospital stay, which is nearly always significantly better than an open procedure. And most of the studies show a significant improvement of VAS leg-and back pain, Oswestry Disability Index and a high fusion rate, but most of the times not significantly different than the open counterpart. When it comes to cost-effectiveness there is a trend in favor of MIS, but to when we want to differentiate MIS from open surgery, comorbidities and complications significantly affect general and disease-specific outcome measures. In our opinion, the actual better outcome of minimal invasive surgery comes down to obtain a good cost-effectiveness study, provided that minimally invasive surgery has an equal or better clinical and radiologic outcome, given that socio-economic, demographic and psychological influencers are equal for both types of surgery. There are no studies done on the subject MIS and low back pain solely. Deriving answers from the difference in VAS back pain in MIS studies reveal a 100% improvement of back pain after surgery. But that does not imply that this procedure, which is still in its childhood, will be the solution to all low back pain patients.Journal of neurosurgical sciences 09/2013; 57(3):203-18. · 1.16 Impact Factor
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ABSTRACT: Transforaminal lumbar interbody fusion (TLIF) through a minimally invasive approach (mTLIF) was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF (oTLIF), but inconsistent outcomes were reported. We conducted a meta-analysis to evaluate the effectiveness of mTLIF and oTLIF in the treatment of degenerative lumbar disease. We searched PubMed, Embase and Cochrane Database of Systematic Reviews in March 2013 for studies directly comparing mTLIF and oTLIF. Patient characteristics, interventions, surgical-related messages, early recovery parameters, long-term clinical outcomes, and complications were extracted and relevant results were pooled. Twelve cohort studies with a total of 830 patients were identified. No significant difference regarding average operating time was observed when comparing mTLIF group with oTLIF group (-0.35 minute, 95% confidence interval (CI): -20.82 to 20.13 minutes). Intraoperative blood loss (-232.91 ml, 95% CI: -322.48 to -143.33 ml) and postoperative drainage (-111.24.ml, 95% CI: -177.43 to -45.05 ml) were significantly lower in the mTLIF group. A shorter hospital stay by about two days was observed in patients who underwent mTLIF (-2.11 days, 95% CI: -2.76 to -1.45 days). With regard to long-term clinical outcomes, no significant difference in visual analog scale score (-0.25, 95% CI: -0.63 to 0.13) was observed; however, there was a slight improvement in Oswestry Disability Index (-1.42, 95% CI: -2.79 to -0.04) during a minimum of 1-year follow-up between the two groups. The incidence of complications did not differ significantly between the procedures (RR = 1.06, 95% CI: 0.7 to 1.59). Reoperation was more common in patients in mTLIF group than in oTLIF group (5% vs. 2.9%), but this difference was not significant (RR = 1.62, 95% CI: 0.75 to 3.51). Current evidence suggests that, compared with traditional open surgery, mTLIF reduces blood loss and allows early postoperative recovery, while achieving comparable or slightly better long-term outcomes, and with a comparable risk of complications.Chinese medical journal 10/2013; 126(20):3962-71. DOI:10.3760/cma.j.issn.0366-6999.20131539 · 1.05 Impact Factor
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